Year: 2026
Type: article
Abstract: Type 1 diabetes mellitus (T1DM) is unique in its treatment, in that patients must perform medical procedures (inject insulin and check blood glucose [BG]) and take important medical decisions (estimate carbohydrate content of meals, calculate pre-meal insulin doses, and judge the need for additional snacking or insulin dose reduction to prevent exercise-induced hypoglycemia) several times each day.Treatment success depends on the patient's ability to learn and adhere to each aspect of diabetes self-management (DSM).us, treatment needs to be individualized, based on the interaction of multiple factors including literacy, intelligence, socioeconomic status, and school/work schedule of the patient and family.In this issue of the journal, Okello et al. present results of a study of adherence to treatment in 91 caregivers of children with T1DM in Kenya, using structured interviewer-administered questionnaires.[1] In their study, only 39.6% of patients adhered to all aspects of T1DM management.Adherence was highest for insulin therapy (75.8%) and lowest for self-monitoring of BG (SMBG) (27.5%).Adherence to diet and physical exercise was 37.4% and 32.9%, respectively.ese findings are not surprising and are consistent with other studies reporting poor overall adherence, with varying levels of adherence across different aspects of treatment.[2,3] More objective methods of studying adherence include analyzing electronic data from the patient's glucometer, continuous glucose monitoring (CGM) device or insulin pump, and studying pharmacy fill data to know how consistently the patient obtains insulin and supplies for SMBG.[4] Merely administering insulin or checking BG regularly does not guarantee good results unless it is done correctly, and in the case of SMBG, followed up with appropriate action.us, combining approaches, e.g., questionnaire with glucometer or CGM data and glycated hemoglobin, to quantify the degree of control, would give a clearer picture.Insights from studies evaluating factors correlated with adherence must be incorporated in management strategies to improve patient outcomes.ese include factors related to the medical facility, provider-patient relationship, person with T1DM (PwD), family members, peers, and the school where children spend a large part of their day.A multidisciplinary team (MDT) with a pediatric endocrinologist, nutritionist, mental health specialist, T1DM educator, and social worker is needed for effective management of T1DM.Team members must have patience, compassion, and excellent communication skills.ey should have in-depth knowledge of the subject and stay up to date with rapid technological advances so that they can promote newer proven technologies in appropriate cases.e initiative by the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) to start an online certificate course for pediatric T1DM educators has fulfilled a long-felt need.[5]
Author: Aspi J. Irani
Institution: Dr. Balabhai Nanavati Hospital
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7141618622