Fear of Needles in Children with T1DM on Insulin Therapy
The demographic features of the participants are shown in Table 2. This patient data set has been previously reported. There were more participants in the CSII group than in the MDI group, and the majority of patients in both groups were males. There were no significant differences between the groups with regards to current age, HbA1c values at the time of the most current visit, or HbA1c values averaged over the past 2 years (P>.05). There were significant differences between the groups with regards to the age at diagnosis, and correspondingly, the time interval since diagnosis.
Based on the caregivers' responses (n = 150), FST was present in 10.0% of participants and FI or FISC was present in 32.7%. Based on the adolescent responses (n = 100), FST was present in 12% and FI or FISC in 22%. Data comparing MDI and CSII for FI/FISC or FST are shown in Table 3. Based upon caregiver responses, more than twice as many CSII patients had a positive FI/FISC score when compared to MDI patients, which was statistically significant. No significant difference was seen for FST between the MDI and CSII groups. Based upon adolescent responses, there were no significant differences between the MDI and CSII groups for either FI/FISC or FST.
A concern could be raised that the difference in caregiver and adolescent responses for FI/FISC is related to the different age ranges (6- to 17-year-old patients for the caregivers and 11- to 17-year-old patients for the adolescents) included in the analyses. To address this, subgroup analyses for caregiver responses were performed for patients 11 to 17 years of age and for patients 6 to 10 years of age. When performed in this manner, there was no significant difference seen between the MDI and CSII groups for caregiver responses for patients 11 to 17 years of age. However, there was a significant difference seen between the MDI and CSII groups for caregiver responses of patients 6 to 10 years of age (Table 3).
When multivariate logistic regression analysis was used based on caregivers' responses for all 150 participants (Table 4), there were significant relationships between the injection group (MDI versus CSII) and the present age to the dependent variable, a positive FI/FISC score. Based on caregivers' responses, positive FST scores were inversely associated with the number of blood sugar checks per day (Table 5). As reported by the adolescent group, increasing age was associated with positive FST scores. There was also no effect of the duration of diabetes on the FI/FISC and FST scores based on the caregiver and adolescent responses (Table 4 and Table 5).
Data for HbA1c as they relate to either FI/FISC or FST are shown in Figures 1 and 2, respectively. The only statistically significant effect seen for the FI/FISC data was elevated HbA1c (2-year average) in subjects with a positive score for FI/FISC, as reported by the caregivers (Fig. 1). A similar effect for the FST data was also found for 2-year average HbA1c and positive FST scores (Fig. 2). The only other significant effect found for the FST data was that the HbA1c values from the most current visit were higher in the CSII group compared with the MDI group, as reported by the adolescent patients with positive FST. The same analysis showed a statistically significant interaction between the method of insulin delivery (MDI versus CSII) and FST.
(Enlarge Image)
Figure 1.
Mean HbA1c (%) values for subjects with fear (FI/FISC) assessed by caregivers (for patients 6 to 17 years of age) and patients (11 to 17 years of age) using either MDI or CSII. Fear was defined as an FI/FISC score ≥6. Four 2-way analyses of variance were run, using fear and injection method as the main treatment effects. Analysis 1: Caregiver response, most current HbA1c – Injection method, P = .874; Fear, P = .234; Interaction, P = .158. Analysis 2: Patient response, most current HbA1c – Injection method, P = .447; Fear, P = .461; Interaction, P = .885. Analysis 3: Caregiver response, HbA1c 2-year average – Injection method, P = .161; Fear, P = .017; Interaction, P =.062. Analysis 4: Patient response, HbA1c two-year average – Injection method, P = .480; Fear, P = .560; Interaction, P = .697. CG = caregiver; CSII = continuous subcutaneous insulin infusion; FI = fear of injections; FISC = fear of infusion site changes; HbA1c = glycated hemoglobin; MDI = multiple daily injections; Pt = patient.
(Enlarge Image)
Figure 2.
Mean HbA1c (%) values for subjects with fear (FST) assessed by caregivers (for patients 6 to 17 years of age) and patients (11 to 17 years of age) using either MDI or CSII. Fear was defined as an FST score ≥6. Four 2-way analyses of variance were run, using fear and injection method as the main treatment effects. Analysis 1: Caregiver response, most current HbA1c – Injection method, P = .102; Fear, P = .084; Interaction, P = .334. Analysis 2: Patient response, most current HbA1c – Injection method, P = .025; Fear, P = .462; Interaction, P = .026. Analysis 3: Caregiver response, HbA1c 2-year average – Injection method, P = .578; Fear, P = .022; Interaction, P = .566. Analysis 4: Patient response, HbA1c 2-year average – Injection method, P = .668; Fear, P = .431; Interaction, P = .292. CG = caregiver; CSII = continuous subcutaneous insulin infusion; FST = fear of self-testing; HbA1c = glycated hemoglobin; MDI = multiple daily injections; Pt = patient.
Results
The demographic features of the participants are shown in Table 2. This patient data set has been previously reported. There were more participants in the CSII group than in the MDI group, and the majority of patients in both groups were males. There were no significant differences between the groups with regards to current age, HbA1c values at the time of the most current visit, or HbA1c values averaged over the past 2 years (P>.05). There were significant differences between the groups with regards to the age at diagnosis, and correspondingly, the time interval since diagnosis.
Based on the caregivers' responses (n = 150), FST was present in 10.0% of participants and FI or FISC was present in 32.7%. Based on the adolescent responses (n = 100), FST was present in 12% and FI or FISC in 22%. Data comparing MDI and CSII for FI/FISC or FST are shown in Table 3. Based upon caregiver responses, more than twice as many CSII patients had a positive FI/FISC score when compared to MDI patients, which was statistically significant. No significant difference was seen for FST between the MDI and CSII groups. Based upon adolescent responses, there were no significant differences between the MDI and CSII groups for either FI/FISC or FST.
A concern could be raised that the difference in caregiver and adolescent responses for FI/FISC is related to the different age ranges (6- to 17-year-old patients for the caregivers and 11- to 17-year-old patients for the adolescents) included in the analyses. To address this, subgroup analyses for caregiver responses were performed for patients 11 to 17 years of age and for patients 6 to 10 years of age. When performed in this manner, there was no significant difference seen between the MDI and CSII groups for caregiver responses for patients 11 to 17 years of age. However, there was a significant difference seen between the MDI and CSII groups for caregiver responses of patients 6 to 10 years of age (Table 3).
When multivariate logistic regression analysis was used based on caregivers' responses for all 150 participants (Table 4), there were significant relationships between the injection group (MDI versus CSII) and the present age to the dependent variable, a positive FI/FISC score. Based on caregivers' responses, positive FST scores were inversely associated with the number of blood sugar checks per day (Table 5). As reported by the adolescent group, increasing age was associated with positive FST scores. There was also no effect of the duration of diabetes on the FI/FISC and FST scores based on the caregiver and adolescent responses (Table 4 and Table 5).
Data for HbA1c as they relate to either FI/FISC or FST are shown in Figures 1 and 2, respectively. The only statistically significant effect seen for the FI/FISC data was elevated HbA1c (2-year average) in subjects with a positive score for FI/FISC, as reported by the caregivers (Fig. 1). A similar effect for the FST data was also found for 2-year average HbA1c and positive FST scores (Fig. 2). The only other significant effect found for the FST data was that the HbA1c values from the most current visit were higher in the CSII group compared with the MDI group, as reported by the adolescent patients with positive FST. The same analysis showed a statistically significant interaction between the method of insulin delivery (MDI versus CSII) and FST.
(Enlarge Image)
Figure 1.
Mean HbA1c (%) values for subjects with fear (FI/FISC) assessed by caregivers (for patients 6 to 17 years of age) and patients (11 to 17 years of age) using either MDI or CSII. Fear was defined as an FI/FISC score ≥6. Four 2-way analyses of variance were run, using fear and injection method as the main treatment effects. Analysis 1: Caregiver response, most current HbA1c – Injection method, P = .874; Fear, P = .234; Interaction, P = .158. Analysis 2: Patient response, most current HbA1c – Injection method, P = .447; Fear, P = .461; Interaction, P = .885. Analysis 3: Caregiver response, HbA1c 2-year average – Injection method, P = .161; Fear, P = .017; Interaction, P =.062. Analysis 4: Patient response, HbA1c two-year average – Injection method, P = .480; Fear, P = .560; Interaction, P = .697. CG = caregiver; CSII = continuous subcutaneous insulin infusion; FI = fear of injections; FISC = fear of infusion site changes; HbA1c = glycated hemoglobin; MDI = multiple daily injections; Pt = patient.
(Enlarge Image)
Figure 2.
Mean HbA1c (%) values for subjects with fear (FST) assessed by caregivers (for patients 6 to 17 years of age) and patients (11 to 17 years of age) using either MDI or CSII. Fear was defined as an FST score ≥6. Four 2-way analyses of variance were run, using fear and injection method as the main treatment effects. Analysis 1: Caregiver response, most current HbA1c – Injection method, P = .102; Fear, P = .084; Interaction, P = .334. Analysis 2: Patient response, most current HbA1c – Injection method, P = .025; Fear, P = .462; Interaction, P = .026. Analysis 3: Caregiver response, HbA1c 2-year average – Injection method, P = .578; Fear, P = .022; Interaction, P = .566. Analysis 4: Patient response, HbA1c 2-year average – Injection method, P = .668; Fear, P = .431; Interaction, P = .292. CG = caregiver; CSII = continuous subcutaneous insulin infusion; FST = fear of self-testing; HbA1c = glycated hemoglobin; MDI = multiple daily injections; Pt = patient.
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