Please enter verification code
Parental Satisfaction on Multiple Daily Injections, Insulin Pump and Flexible Multiple Daily Injections Used for Children with Type 1 Diabetes Mellitus
American Journal of Pediatrics
Volume 5, Issue 2, June 2019, Pages: 43-50
Received: Dec. 16, 2018; Accepted: Jan. 28, 2019; Published: May 10, 2019
Views 884      Downloads 106
Anutosh Shee, Department of Paediatrics, University of Tasmania, Tasmania, Australia
Sarah Prior, Clinical School, University of Tasmania, Tasmania, Australia
Nicole Reeves, Clinical School, University of Tasmania, Tasmania, Australia
Maria Smith, Tasmanian Health Service, Tasmania, Australia
Sharon Luccisano, Tasmanian Health Service, Tasmania, Australia
Article Tools
Follow on us
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.
Type 1 Diabetes Mellitus, Continuous Subcutaneous Insulin Infusion, Flexible Multiple Daily Injection, Multiple Daily Injection, Insulin Treatment Satisfaction Questionnaire, Diabetes Treatment Satisfaction Questionnaire
To cite this article
Anutosh Shee, Sarah Prior, Nicole Reeves, Maria Smith, Sharon Luccisano, Parental Satisfaction on Multiple Daily Injections, Insulin Pump and Flexible Multiple Daily Injections Used for Children with Type 1 Diabetes Mellitus, American Journal of Pediatrics. Vol. 5, No. 2, 2019, pp. 43-50. doi: 10.11648/j.ajp.20190502.12
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aihw. Prevalence of Type I diabetes among children aged 0-15 in Australia. 2013; (24): 1–24.
Nathan DM. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: Overview. Diabetes Care. 2014; 37 (1): 9–16.
Li YLA. Quality of Life in Parents of Children with Type 1 Diabetes Receiving Insulin Treatment. [Internet]. Quality of Life in Parents of Children with Type 1 Diabetes Receiving Insulin Treatment. 2014.
Szypowska A, Schwandt A, Svensson J, Shalitin S, Cardona-Hernandez R, Forsander G, et al. Insulin pump therapy in children with type 1 diabetes: analysis of data from the SWEET registry. Pediatr Diabetes. 2016; 17: 38–45.
Opipari-arrigan L, Fredericks EM, Burkhart N, Dale L, Hodge M, Foster C. Continuous subcutaneous insulin infusion benefits quality of life in preschool-age children with type 1 diabetes mellitus. Pediatr Diabetes. 2007; 8 (6): 377–83.
Hughes CR, McDowell N, Cody D, Costigan C. Sustained benefits of continuous subcutaneous insulin infusion. Arch Dis Childhood [Internet]. 2010; 25.
Cappelleri JC, Gerber RA, Quattrin T, Deutschmann R, Luo X, Arbuckle R, et al. Development and validation of the WEll-being and Satisfaction of CAREgivers of Children with Diabetes Questionnaire (WE-CARE). Health Qual Life Outcomes. 2008 Jan; 6: 3.
Group DS. Training in flexible, intensive insulin management to enable dietary freedom in people with Type 1 diabetes: dose adjustment for normal eating (DAFNE) randomized controlled trial. Diabet Med. 2003;20 Suppl 3:4–5.
Alemzadeh R, Palma-Sisto P, Parton E, Totka J, Kirby M. Beneficial effects of flexible insulin therapy in children and adolescents with type 1 diabetes mellitus. Acta Diabetol. 2003; 40 (3): 137–42.
Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study. Diabet Med. 2012; 29 (5): 682–9.
Schwartz DD, Cline VD, Axelrad ME, Anderson BJ. Feasibility, acceptability, and predictive validity of a psychosocial screening program for children and youth newly diagnosed with type 1 diabetes. Diabetes Care. 2011; 34 (2): 326–31.
Johnson SR, Cooper MN, Davis E a, Jones TW. Hypoglycaemia, fear of hypoglycaemia and quality of life in children with Type 1 diabetes and their parents. Diabet Med [Internet]. 2013; 30 (9): 1126–31.
Diabetes P. The importance of carbohydrate counting in the treatment of children with diabetes The importance of carbohydrate counting in the treatment of children with diabetes. 2015; 8 (NOVEMBER 2007): 57–62.
Hussain T, Akle M, Nagelkerke N, Deeb A. Comparative study on treatment satisfaction and health perception in children and adolescents with type 1 diabetes mellitus on multiple daily injection of insulin, insulin pump and sensor-augmented pump therapy. SAGE Open Med [Internet]. 2017; 5:205031211769493.
H. G, J. C, E. H, B. S. O, T. B, I. C, et al. The switch study: The impact of continuous glucose monitoring on quality of life and treatment satisfaction [Internet]. Vol. 15, Value in Health. 2012. p. A359.
Barnard KD, Wysocki T, Ully V, Mader JK, Pieber TR, Thabit H, et al. Insulin pump therapy: impact on the lives of children/young people with diabetes mellitus and their parents. Int J Clin Pharm. 2008 Nov; 105 (11): 927–31.
A. T, R. B, D. I, et al. The social acceptance of future artificial pancreas technology: Parents’ perceptions of pedarpan (pediatrics artificial pancreas). Diabetes Ther [Internet]. 2016; 18: A46--A47.
van Golen LW, Veltman DJ, IJzerman RG, Deijen JB, Heijboer AC, Barkhof F, et al. Effects of Insulin Detemir and NPH Insulin on Body Weight and Appetite-Regulating Brain Regions in Human Type 1 Diabetes: A Randomized Controlled Trial. PLoS One [Internet]. 2014; 9 (4): e94483.
Danne T, Rstam J, Odendahl R, et al. Parental preference of prandial insulin aspart compared with pre-prandial human insulin in a basal-bolus scheme with NPH insulin in a 12-wk crossover study of preschool children with type 1 diabetes. Pediatr Diabetes. 2007; 8 (5): 278–85.
Pańkowska E, Nazim J, Szalecki M, Urban M. Equal Metabolic Control but Superior Caregiver Treatment Satisfaction with Insulin Aspart in Preschool Children. Diabetes Technol Ther [Internet]. 2010; 12 (5): 413–8.
Monaghan M, Hilliard ME, Cogen FR, Streisand R. Supporting parents of very young children with type 1 diabetes: Results from a pilot study. Patient Educ Couns. 2011; 82 (2): 271–4.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186