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Observational Study
. 2016 May 3;10(3):724-9.
doi: 10.1177/1932296815623568. Print 2016 May.

White Coat Adherence in Pediatric Patients With Type 1 Diabetes Who Use Insulin Pumps

Kimberly A Driscoll  1 , Yuxia Wang  2 , Suzanne Bennett Johnson  2 , Rebecca Lynch  3 , Haley Stephens  3 , Katelyn Willbur  4 , Elizabeth Gill  2 , Nancy Wright  2 , Larry C Deeb  2
Affiliations
Observational Study

White Coat Adherence in Pediatric Patients With Type 1 Diabetes Who Use Insulin Pumps

Kimberly A Driscoll et al. J Diabetes Sci Technol. .

Abstract

Background: The purpose was to assess the occurrence of white coat adherence, defined as an increase in adherence to treatment regimens prior to a clinic appointment, in children and adolescents with type 1 diabetes (T1D) who use insulin pumps.

Methods: Blood glucose monitoring (BGM) data, carbohydrate inputs, and insulin boluses delivered were downloaded from the insulin pumps of children and adolescents, aged 7-19 years with T1D, at 2 consecutive routine diabetes clinic visits. Linear mixed models were used to analyze patterns of BGM, carbohydrate inputs, and insulin boluses delivered in patients who had ≥28 days of data stored in their insulin pumps.

Results: In general, younger children engaged in more frequent BGM, carbohydrate inputs, and insulin boluses delivered than older children and adolescents. White coat adherence occurred with frequency of BGM, carbohydrate inputs, and insulin boluses delivered, but only in younger children.

Conclusions: Diabetes care providers need to be aware that white coat adherence may occur, particularly in young children. Providers routinely download meter and insulin pump data for the 1- to 2-week period before the clinic visit. For patients exhibiting white coat adherence, their data will overestimate the patient's actual adherence.

Keywords: adherence; adolescents; blood glucose; carbohydrate inputs; children; insulin bolusing.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Illustration of white coat adherence in children, but not adolescents.
See this image and copyright information in PMC

References

    1. Driscoll KA, Johnson SB, Hogan J, Gill E, Wright N, Deeb LC. Insulin bolusing software: the potential to optimize health outcomes in type 1 diabetes mellitus. J Diabetes Sci Technol. 2013;7:646-652. - PMC - PubMed
    1. Cramer JA. Microelectronic systems for monitoring and enhancing patient compliance with medication regimens. Drugs. 1995;493:321-327. - PubMed
    1. Krejci-Manwaring J, Tusa MG, Carroll C, et al. Stealth monitoring of adherence to topical medication: adherence is very poor in children with atopic dermatitis. J Am Acad Dermatol. 2007;56:211-216. - PubMed
    1. Podsadecki TJ, Vrijens BC, Tousset EP, Rode RA, Hanna GJ. “White coat compliance” limits the reliability of therapeutic drug monitoring in HIV-1-infected patients. HIV Clin Trials. 2008;9:238-246. - PubMed
    1. Modi AC, Rausch JR, Glauser TA. Patterns of nonadherence to antiepileptic drug therapy in children with newly diagnosed epilepsy. JAMA. 2011;305:1669-1676. - PMC - PubMed

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