White Coat Adherence in Pediatric Patients With Type 1 Diabetes Who Use Insulin Pumps

J Diabetes Sci Technol. 2016 May 3;10(3):724-9. doi: 10.1177/1932296815623568. Print 2016 May.


Background: The purpose was to assess the occurrence of white coat adherence, defined as an increase in adherence to treatment regimens prior to a clinic appointment, in children and adolescents with type 1 diabetes (T1D) who use insulin pumps.

Methods: Blood glucose monitoring (BGM) data, carbohydrate inputs, and insulin boluses delivered were downloaded from the insulin pumps of children and adolescents, aged 7-19 years with T1D, at 2 consecutive routine diabetes clinic visits. Linear mixed models were used to analyze patterns of BGM, carbohydrate inputs, and insulin boluses delivered in patients who had ≥28 days of data stored in their insulin pumps.

Results: In general, younger children engaged in more frequent BGM, carbohydrate inputs, and insulin boluses delivered than older children and adolescents. White coat adherence occurred with frequency of BGM, carbohydrate inputs, and insulin boluses delivered, but only in younger children.

Conclusions: Diabetes care providers need to be aware that white coat adherence may occur, particularly in young children. Providers routinely download meter and insulin pump data for the 1- to 2-week period before the clinic visit. For patients exhibiting white coat adherence, their data will overestimate the patient's actual adherence.

Keywords: adherence; adolescents; blood glucose; carbohydrate inputs; children; insulin bolusing.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Blood Glucose / analysis
  • Blood Glucose Self-Monitoring
  • Child
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Female
  • Humans
  • Insulin Infusion Systems*
  • Male
  • Patient Compliance / statistics & numerical data*
  • Young Adult


  • Blood Glucose