Parental satisfaction on multiple daily injections, insulin pump and flexible multiple daily injections used for children with Type 1 diabetes mellitus

Aims: This study aims to identify differences in parental satisfaction between three distinct types of intensive insulin therapies used for children with type 1 diabetes (T1D) namely multiple daily injection (MDI), continuous subcutaneous insulin infusion (CSII) and flexible multiple daily injection (fMDI).

Materials and Methods: Data was collected over a 6-month period during the quarterly clinic visits. Two modified versions of validated tools- Insulin Treatment Satisfaction Questionnaire (ITSQ) and Diabetes Treatment Satisfaction Questionnaire (DTSQ), were electronically filled in by the parents of children with T1D. This provided information on parental satisfaction on the following areas: inconvenience of regimen, lifestyle flexibility, impression of glycaemic control, fear of hypoglycaemia, diabetic symptoms, treatment barriers, worry, treatment adherence and communication.

Results: 34 parents completed the electronic data forms on iSurvey. Parents of the fMDI group were the most confident to avoid severe hypoglycaemia whereas MDI-parents being the least confident, t (21) = 2.12, p = 0.046. There was no statistical difference noted on how confident parents felt to avoid asymptomatic hypoglycaemia, their worry about nocturnal hypoglycaemia, convenience and ease of using insulin in public places, nor was there statistically significant difference in the pain and discomfort felt by their children. Parents of children with fMDI felt the time their children spent with hyperglycemia was higher than the MDI, t (21) = 2.11, p = 0.047. Parents of the CSII group were most likely to continue their current treatment and were also, most likely to recommend the treatment regimen to others. Parents of MDI were least likely to do so, t (20) = 2.12, p =.047 and t (18) = 2.35, p = 0.031.

Conclusion: Although this study was conducted with a very small sample size, it has revealed no significant difference in parental satisfaction among MDI, CSII and fMDI groups including parental anxiety and stress, ease of use in public places, convenience, flexibility, parental perception of pain and discomfort experienced by their children and fear of nocturnal hypoglycaemia. However, parents indicated greater confidence in avoiding severe hypoglycaemia in fMDI albeit there was higher glycaemic variability. Parents with CSII were more satisfied with treatment and more likely to recommend their current treatment option to others, than fMDI and MDI, as the preferred mode of treatment.