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. 2025 Mar;19(2):340-344.
doi: 10.1177/19322968231192979. Epub 2023 Aug 11.

Mealtime Insulin BOLUS Score More Strongly Predicts HbA1c Than the Self-Care Inventory in Youth With Type 1 Diabetes

Jordan Christie  1 , Mark A Clements  1 , David D Williams  2 , Joseph Cernich  1 , Susana R Patton  3
Affiliations

Mealtime Insulin BOLUS Score More Strongly Predicts HbA1c Than the Self-Care Inventory in Youth With Type 1 Diabetes

Jordan Christie et al. J Diabetes Sci Technol. 2025 Mar.

Abstract

Background: To meet their glycated hemoglobin (HbA1c) goals, youth with type 1 diabetes (T1D) need to engage with their daily T1D treatment. The mealtime insulin Bolus score (BOLUS) is an objective measure of youth's T1D engagement which we have previously shown to be superior to other objective engagement measures in predicting youth's HbA1c. Here, to further assess the BOLUS score's validity, we compared the strengths of the associations between youth's HbA1c with their mean insulin BOLUS score and a valid, self-report measure of T1D engagement, the Self-Care Inventory (SCI).

Methods: One-hundred and five youth with T1D self-reported their T1D engagement using the SCI. We also collected two weeks of insulin pump data and a concurrent HbA1c level. We scored youth's SCI and calculated their mean insulin BOLUS score using standardized methods. For the analyses, we performed simple correlations, partial correlations, and multiple regression models.

Results: Youth had a mean age of 15.03 ± 1.97 years, mean time since diagnosis of 8.11 ± 3.26 years, and a mean HbA1c of 8.78 ± 1.49%. The sample included n = 58 boys (55%) and n = 96 families (91%) self-identified as white. Simple correlations between youth's age, HbA1c, SCI total score, and BOLUS score were all significant. Partial correlation and regression models revealed that youth's insulin BOLUS score was more strongly associated with HbA1c than the SCI.

Conclusions: Youths' BOLUS score has better concurrent validity with HbA1c than the SCI. We should consider reporting the BOLUS score as an outcome metric in insulin pump data reports.

Keywords: insulin pump; pediatrics; treatment engagement; type 1 diabetes.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Mark A. Clements is Chief Medical Officer of Glooko, Inc and has received grants or contracts from Dexcom, Abbott Diabetes Care, National Institutes of Health, JDRF, the Emily Rosebud Foundation, Eli Lilly, Tolerion, and Garmin. Dr Susana R. Patton has received grants from the National Institutes of Health.

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