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Eur Endocrinol. 2019 Apr;15(1):1-5. doi: 10.17925/EE.2019.15.1.1. Epub 2019 Apr 12.

A New Paediatric Diabetes Knowledge Test - M-WIKAD Development and Factor Analysis.

Author information

Division of Pediatric Endocrinology, Children's Mercy Kansas City, Kansas City, MO, USA.
University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO, USA.
Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA.
Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City MO, USA.


Purpose: The purpose of this study was to develop a measure of type 1 diabetes mellitus (T1DM) knowledge that is aimed at youth and is based on contemporary management standards. Methods: An 88-item test was derived from the American Association of Diabetes Educators 7 Self-Care Behaviors. Results: A multidisciplinary team selected the best 49 items which were piloted in a sample of 119 youths (59 males, aged 12-18, having a mean ± standard deviation glycated haemoglobin (A1C) of 9.9%±1.80 (84.7±19.7 mmol/mol). A minimum absolute point-biserial correlation coefficient of 0.250 was used to choose 49 items from the original 88 questions. Categorical principal component analysis was then used to identify the best factor analytical model that consisted of five factors composed of 19 items. These five factors explained 57% of item variances. Factors were associated with the latent variables: advanced problem-solving, hypoglycaemia prevention and management, taking insulin/medication administration, daily management and healthy active living. Conclusion: A new T1D knowledge test for youth was refined from 88 to 49 questions based on expert opinion and empirical test construction. The instrument was then refined to 19 items based on exploratory factor analysis. Future goals are to validate this factor model with another cohort and confirm concurrent validity based on youth's glycated haemoglobin and adherence behaviours. Our new T1DM knowledge measure initially appears valid and promising as a new clinical and research tool.


Type 1 diabetes mellitus; exploratory factor analysis; paediatric

Conflict of interest statement

Disclosure: Melinda Storm works for Insulet, however, she did not work for this company during the development of this project or writing of the manuscript. Sarah Tsai, Susana Patton, Stephen DeLurgio, David D Williams, Kavitha Dileepan, Alexander Karmazin and Mark Clements have no conflicts of interest to disclose.

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