The maximum overall obtainable score was 78/78, with a maximum score of 58/78 in the carbohydrate knowledge domain and 20/78 in the insulin-dosing knowledge domain. Average PCQ scores were: Total 68.9 ± 15.8%, carbohydrate 68.7 ± 16.3%, and insulin 68.9 ± 24.9%. No participant obtained a perfect score in the carbohydrate domain or overall, but 8 participants obtained a perfect score in the insulin-dosing domain. 2 of these participants belonged to the CSII group and 6 in the MDI group.
The CSII group compared with the MDI group had a higher average total PCQ score (79.1 ± 12.1% versus 65.9 ± 16.6% p = 0.005) and higher average carbohydrate score (79.4 ± 12.4% versus 66.3 ± 16.2%, p = 0.004) but there was no difference for average insulin score (78.2 ± 21.8% versus 66.8 ± 25.4%, p = 0.108).
PCQ scores showed no significant correlation with gender, age, age at diagnosis, HbA1c or diabetes duration.
Our study identified higher knowledge of carbohydrate counting and insulin dosing in paediatric T1DM patients treated with CSII compared with MDI. This is consistent with best practise, where patients receive carbohydrate counting prior to starting CSII therapy. The scores from our Irish cohort were lower than those from the original US cohort, indicating poorer knowledge of carbohydrates and insulin in our patients. Disappointingly, only 57% of our patients had been taught carbohydrate and insulin skills by a dietitian, compared with all of the patients in the American study. The low levels of dietitian-led carbohydrate teaching are due to significant dietetic resource limitations at UHL prior to this study. Nonetheless, we did not ask at which institution dietetic education was received, and for some patients, this may have been elsewhere. Even patients who have already started CSII therapy should have ongoing education with a diabetes dietitian and this was not possible at UHL during the study period. This study measures knowledge of carbohydrate counting and insulin dose calculations, but it does not measure the real-life behaviour of patients in calculating and administering insulin doses.
Our study has limitations. The PCQ was developed for a US population and adaptations for our Irish populations were difficult, e.g. some food types might not be commonly consumed among Irish children. Disappointingly, we had a low response rate to this study. It is possible that only patients with confidence in their carbohydrate and insulin skills might have consented to this study. In this case, the true PCQ knowledge of our cohort may be significantly lower than indicated in this study. Thirdly, while some results reach statistical significance, clinical significance in different PCQ scores is difficult to estimate. However, this is a novel study in an Irish population and the results are interesting; specifically, the results suggest suboptimal carbohydrate and insulin calculation knowledge compared with a large American centre where all patients receive dietetic education.
This study demonstrates that in a representative Irish regional paediatric T1DM clinic, knowledge of carbohydrates and insulin is better among patients treated with CSII compared with MDI. However, knowledge in both groups is poorer than in the original US sample. No patient treated with a regime other than CSII or MDI agreed to participate. Some patients in our study group received dietetic input even in the absence of a paediatric diabetes dietitian as part of the MDT, either in another hospital or privately. In either case, follow-up consultations and integrating information to the rest of the MDT education would have been difficult for the family. A notable difference between the Irish and US cohorts is the significant dietetic resource limitation in the Irish cohort. Following investment in dietetic support to this clinic, with consequent increased teaching of carbohydrate and insulin skills to our patient population, we intend to repeat this study.