Development and evaluation of a low-literacy scale for estimating insulin correction dose for hyperglycemia among children with type 1 diabetes

Low-literacy parents of children with type 1 diabetes (T1D) often fail to estimate insulin correction dose (ICD) for hyperglycemia, causing poor diabetes control. A tool to estimate ICD for hyperglycemia, which requires singling out glucometer readings digit-wise, was developed and evaluated.

In this prospective trial, illiterate parent dyads of children with T1D were identified among all children admitted during January-March, 2022. They were sufficiently trained to use a “finger chart” for ICD determination for hyperglycemia. The “finger chart” requires singling out the glucometer readings digit-wise and then moving across the rows and columns to reach the needed ICD. Glycemic control was compared among participants using finger chart and the rest of the families at 3 and 6 months from baseline.

Twelve parent-dyads (28%) used finger chart (IG), and the rest 31 (72%) determined the ICD themselves (CG). More families in the IG lived in rural habitats (83.3% vs 58.1%) and had lower socio-economic status and maternal education (p 0.003, p < 0.001, respectively). The body mass index, HbA1C, and frequency of low and high BGs were similar between the two groups at 3 months (p 0.71, 0.41, 0.78, 0.55, respectively) and 6 months (p 0.17, 0.69, 0.89, 0.30, respectively). Total daily insulin dose was higher in the IG at 3 months (p 0.003) but was comparable at 6 months (p 0.23).

This low-literacy tool can effectively help parents with low literacy in determining the ICD among children with T1D. This tool can be used in other low-literacy settings for ICD determination by suitable translation in local languages.

Prior ethical approval was obtained from the Institute Ethics Committee, Post Graduate Institute of Medical Education and Research (PGIMER) (INT/IEC/2021/SPL-252 dated 13 February, 2021). The trial was registered with the Clinical Trials Registry of India. Registration number: CTRI/2021/04/032739, Registered on 12 April, 2021, http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=52647&EncHid=&userName=Type%201%20diabetes.