Enhancing Blood Glucose Awareness in Adolescents and Young Adults With IDDM

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Abstract
Objective To determine the effectiveness of an intervention program designed to improve blood glucose awareness. Research Design and Methods Eight young-adult outpatients (mean age 22 yr) and six adolescent inpatients (mean age 14.5 yr) with insulin-dependent diabetes mellitus participated in the intervention program. Nine adolescent inpatients (mean age 13.9 yr) served as an untreated comparison group. One adult outpatient with unreliable data was removed. Before treatment, each patient completed a minimum of 40 blood glucose estimations, blood glucose tests, and symptom-rating checklists. Symptoms of hypo- or hyperglycemia were identified for each patient. The three-session intervention focused on internal (e.g., personal symptoms) and external (e.g., timing and amount of insulin, food, and exercise) cues that could be used to enhance blood glucose awareness. At postintervention, patients completed a minimum of 40 additional blood glucose estimates and tests. Comparison subjects completed the pre-postassessments but did not receive the intervention. Results Blood glucose estimation accuracy was evaluated with error grid analysis. All estimated-actual blood glucose values were plotted into one of five zones: accurate estimates (zone A), benign errors (zone B), and clinically dangerous errors (zones C, D, and E). An overall accuracy index (AI) was calculated by subtracting the summed percentage of clinically dangerous estimates (zones C, D, and E) from the percentage of accurate estimates (zone A). At study entry, the adolescent inpatients' mean AI of 7% was significantly poorer than the 32% mean AI exhibited by the outpatient young-adult sample (P < 0.02). At postintervention, the adolescents' mean AI improved to 30% (P < 0.02) and the young adults' mean outpatient AI improved to 45% (P < 0.06). The treated sample as a whole exhibited increased sensitivity to both hypo- (P < 0.005) and hyperglycemia (P < 0.05). Similar improvements did not occur in the untreated comparison sample. Conclusions Adolescents may exhibit poorer blood glucose awareness than adults. Although this intervention program improved blood glucose awareness in both adolescent and adult patients, postintervention blood glucose estimation accuracy remained far from ideal.
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