Diabetes and distraction

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Holiday distractions have been linked to up to a 20% reduction in medicines adherence in children with type 1 diabetes, new research has found

The research, published in Archives of Disease in Childhood, looked at 90 Adelaide children, aged eight to 18, with type 1 diabetes.

The researchers found that during school holidays – and on weekends – the children found it more difficult to stick to their medicines regimes, which the researchers say may have significant consequences for their health.

The children participated in a 12-month double-blind, randomised, placebo-controlled trial, and provided 28,336 days of study observations: 7138 school holiday, and 8875 weekends and public holiday days.

“Adherence to intervention (metformin (n=45) or placebo (n=45)) was measured objectively by Medication Event Monitoring Systems (MEMS) including proportion of medication doses taken and daily adherence patterns and by tablet count at three, six and 12 months,” the researchers noted.

The trial was completed in June 2015.

“There was an average (SD) of 363.3 (42) days of MEMS observations available for each study participant (94.1 (12.6) school holiday days and 117.1 (13.4) weekend/public holiday days).

“Adherence reduced during school holidays (adjusted OR (aOR) 0.81; 95% CI 0.72 to 0.91; p<0.001) and during weekends/public holidays (aOR 0.74; 95% CI 0.69 to 0.80; p<0.001). Adverse effects to the intervention did not affect overall adherence (aOR 0.77; 95% CI 0.3 to 2.01; p=0.6).

“Age, gender, body mass index, diabetes duration, insulin dose, HbA1c (Haemoglobin A1c) or socioeconomic status did not predict adherence.”

“Chronic non-communicable diseases, including T1D, are increasingly prevalent in childhood and treatment is becoming more complex with combination therapies being common to manage the disease and associated conditions,” said Dr Alexia Peña, Senior Lecturer from The University of Adelaide’s Robinson Research Institute and Paediatric Endocrinologist at the Women’s and Children’s Hospital.

“There was approximately a 20% reduction in treatment adherence during school holidays, weekends and public holidays in children with T1D,” says Dr Peña.

“As school holidays and weekends account for 25% and 30%, respectively, of a calendar year in Australia, the impact of non-adherence to medical treatment in childhood has serious consequences for an individual’s health and substantially increases demand and expenditure on health systems.

“A 25% reduction in adherence has been associated with significant increases in hospitalisation and mortality in adults with T1D.

“Clinicians should be aware of adherence issues during holidays and weekends. Targeted reminders and additional strategies are necessary to improve adherence during these less structured periods for school children and their families.

“These will ensure benefit from their treatment especially in children with chronic conditions.

“There is a need to develop targeted strategies to enhance adherence during vulnerable periods in these children, improving overall quality of healthcare.

“This is the first study of children with T1D. Similar challenges of adhering to drug therapies were found in a study of children with cystic fibrosis which suggests that these problems may extend to other chronic diseases,” says Dr Peña.

The research was supported by Diabetes Australia, Australasian Paediatric Endocrine Care, and the Women’s and Children’s Hospital Foundation.

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