International Journal of Pediatrics
Volume:10 Issue: 97, Jan 2022

Physical literacy is required for achieving a healthy and active lifestyle among adolescents. Additionally, an improvement in physical literacy affects the prevention of the diseases caused by the lack of physical activity such as obesity and diabetes positively. So far, no comprehensive program has been developed and operated for enhancing adolescents' physical literacy although policymakers and stakeholders currently advocate physical literacy programs and interventions. The present study aimed to identify the dimensions and concept of the physical literacy of 16-18-year-old adolescents. The participants were selected purposefully with the maximum diversity among specialists in the health education and health promotion, and physical education specialists, as well as 16-18-year-old male and female adolescents until reaching information saturation. Further, semi-structured interviews were performed face-to-face with 26 participants. Data were analyzed based on the content analysis of Graneheim and Lundman. The results suggested four themes of self-care and information acquisition, comprehension, and assessment skills for adolescents' physical literacy and the participants mostly emphasized self-care skill. Based on the themes emerged in the qualitative study, the physical literacy of adolescents can be defined as a set of the skills for information acquisition, comprehension, assessment, and self-care to make the right decisions to maintain and improve physical activities. The study findings can be applied as a basis for educational interventions to strengthen adolescents' physical literacy.

In the face of mistakes and individual shortcomings, self-compassion defines a positive and loving attitude of a person towards her or himself. As a consequence of this compassionate mindset, it is believed that people with high self-compassion experience better control over pathological internalization. The aim of this study was to investigate the moderating role of self-compassion in the relationship between the use of visual media and internalization of pathological symptoms in adolescents in the academic year 2019-2020.
This study has a cross sectional and correlational research design. The statistical population included all high school students in Shiraz, Iran, who were randomly selected as a cluster of 300 students from educational areas one and two. To measure the studied variables, the questionnaire of self-compassion along with the strengths and difficulties questionnaire (SDQ) were used. To analyze the data and hypotheses, review and compare the factors measured in students, Chi-square tests, Pearson correlation coefficient, and hierarchical regression were used at a significance level of 0.05.
According to the demographic data, 162 (49.40 %) of the sample were female and (48.46 %) were male. The results showed that the variables of self-compassion and body image concern play a moderating role in the relationship between the use of visual media and internalization of pathological symptoms (β=0.296).
Self-compassion and body image concern play a significant moderating role in the relationship between the use of visual media and the internalization of pathological symptoms.

Hyperglycemic stress is a transient increase in blood glucose during an acute physiological stress in the absence of diabetes. In children, a blood glucose level of >150 mg/dl is considered as hyperglycemia. The purpose of this study was determining the frequency of hyperglycemic stress based on the underlying diseases in patients referred to the emergency department of a pediatric hospital in Mashhad-Iran.
This cross-sectional study enjoyed census sampling method. Participants of the study were 201 patients including 120 boys (59.7%) and 81 girls (40.3%) with mean age of 3.01 ± 3.03 years (age range: 2 months to 15 years). Both qualitative and quantitative data were collected and analyzed using descriptive statistics and SPSS software version 21. Chi-square test was used to compare the qualitative variables. For quantitative statistical analysis, normality of data was evaluated by Smirnov Kolmogorov tests. Afterwards, Pearson correlation test and independent T test were used for analyzing the quantitative data.
Findings revealed that there is not any significant correlation between the type of disease and hyperglycemia, while temperature and dehydration are directly associated with hyperglycemia. Furthermore, no connection was found between convulsion and the risk of increased glucose level, but status seizure had an important role in hyperglycemia. In fact, the degree of hyperglycemia increased with worsening the disease.
The severity of disease, high body temperature and dehydration rate are important risk factors in the rate and severity of hyperglycemia.

Congenital scoliosis (CS) is a challenging entity in spinal surgery. Convex growth arrest (CGA) is a therapeutic method aiming at inhibiting growth on the curve convexity while remaining growth of concavity corrects the scoliotic curve over time. In the view of controversies in current clinical studies for efficiency of CGA in CS patients, we performed a systematic review of the literature to clarify the debate. 

A comprehensive literature search was performed to identify studies assessing CGA outcome in CS patients, in following databases and search engines: Ovid MEDLINE, PubMed, Scopus, Cochrane Central Register of Controlled Trials (CCTR), EMBASE, Google Scholar, and Web of Science. Two authors screened the search results and selected the studies by the supervision of senior authors.

In 19 studies, including 363 patients, age at surgery was 58.76 months ranging from 4 to 216 months. Anterior and posterior hemiepiphysiodesis was the most common approach. Eight studies added instrumentation to CGA. Follow-up mean was 64.57 months. Nine studies reported true epiphysiodesis effect (postoperative and final follow-up CCA difference): from among 162 patients, 69 improved, 59 stabilized, and 34 progressed. Other studies reported preoperative and final follow-up CCA difference: among 88 patients, 49 improved, 32 stabilized, and 7 progressed. Preoperative curve magnitude, sagittal plane deformities, age <5 years, and type of spinal anomalies did not affect CGA outcome. Instrumentation was preferred in complicated spinal anomalies and older ages.

CGA alone or with instrumentation is a feasible CS treatment, however the criteria for choosing suitable candidates need reconsideration.

Behavioral disorders in children and adolescents are common and debilitating problems, which are usually seen for the first time in the early years of elementary school. Therefore, the present study aimed to develop a yoga-based educational package and determine its effectiveness on behavioral and emotional disorders in children.
The first phase was to develop a training package with a qualitative method and the second phase was to evaluate its effectiveness through a quasi-experimental design (pre-test-post-test with a control group). The statistical population of the study in the first phase included all professors and experts in the field of child psychology and mindfulness, physical education, and yoga in 1398-1397 that 7 of these experts were selected by judgment and the content validity of the educational package was confirmed. The statistical population of the research in the second phase was the 7-10-year-old female children of the Welfare Organization of Tehran in 1398-1397. Welfare girl children aged 7-10 years were selected by available sampling based on entry and exit criteria. Ackenbach (1991) questionnaire was used to collect information and a yoga-based mindfulness training package (researcher-made) was used for teaching. Data was analyzed by multivariate analysis of covariance.
The mindfulness training package had a significant effect on three dependent variables of anxiety, depression, and aggression (p <0.001). The coefficient of effectiveness in reducing anxiety was 83%, depression was 42.3%, and aggression was 82.7%.
The results of the present study support the hypothesis that a yoga-based mindfulness training package is effective in reducing the symptoms of emotional behavioral disorders in children.

Many psychological factors can arise during the student's school years that can have a positive or negative effect on their academic life as well as their learning process. Therefore, the present study aimed to explore the structural model for predicting academic adaptation based on perception of classroom environment and family functioning among female high school students.
The approach used in this analysis was the structural equation modelling (SEM). The statistical population of this study included all secondary high school female students in Sari, in the academic year of 2019-2020. Based on the table by Jesse and Morgan, multi-stage sampling was performed to select 450 individuals. They answered Baker and Siryk’s Student Adaptation to College Questionnaire (SACQ), Classroom Perceptions Questionnaire (CPQ), and the Developmental Family Functioning Assessment Questionnaire (DFFAQ). Using SPSS software version 26.0. to analyze data.
The highest percentage of the participants consisted of the 16-year-old students, (n=211, 46.4%), and the lowest number of participants were 17 years old n=78, 17.1%). According to the results, the perception of the classroom environment (β= 0.561, P=0.01) and the measure of family functioning (β= 0.747, P=0.01) were both positively influenced by academic adaptation.
The findings of this study indicated that classroom environment and family functioning for progress significantly predict the students' academic adjustment among Sari high school's second-year female students.

The interaction between premature infants and the ectopic environment requires special care due to developmental defects in various systems of their body. In this regard, the results of various studies have introduced the stimulation of premature infants with the smell of breast milk as an effective way to improve the physiological responses caused by prematurity and reduce the problems associated with prematurity. The aim of this study was to systematically review the intervention studies of aromatherapy with breast milk on improving behavioral and physiological responses and reducing prematurity problems in premature infants. A comprehensive search of related scientific studies, published until February 2020, was conducted in scientific databases of PubMed, ISI, Web of Science, Cochrane Library,  and  Scopus using the following keywords: Breast Milk, Maternal Milk odor, Mother's Milk, Mother's odor, Premature Birth, Olfactive stimulation, Pain, Aromatherapy, Apnea, Preterm infant, Preterm infant pain, Infant behavior, Infant physiological response. After applying the entry and exit criteria, 14 Articles were selected. The results revealed a decrease in transition feeding days in premature infants of the intervention group in exposure to an impregnated pad with breast milk as olfactory stimulation, when compared to the control group. Based on the results, longer sucking bouts, more bursts (>7 sucking movements) and more consumed milk were reported for the intervention group during each breastfeeding session, when compared to the control group. The frequency of sucking in response to fresh breast milk was also higher than frozen breast milk, but not statistically significant (p = 0.09). There was an elevation in the high-amplitude non-nutritive sucking frequency among the preterm infants within the last three days of 14-day study after presenting the odor of the maternal breast milk for a 60-second period. Beneficial effects occurred in the hospitalized infants due to the odor of mother; they included increasing mouth movements and pacifier acceptance, calming stressed or crying infants, and relieving their pain. The infant's ability to feed increases and the duration of the first lactation decreases due to the olfactory stimulation of the breast milk odor; and the number of sucks (260.4 [95% CI = 206-315]) and suck bursts (41.0 [95% CI = 36-46]) was unexpectedly observed in group 1 (breast milk odor), as compared to group 2 (144.8 [95% CI = 87-203] versus 27.4 [95% CI = 21-34]) This study showed that the use of aromatherapy with the mom’s milk is very effective in improving the behavioral and physiological response; and reduces the problems resulting from prematurity in premature babies. Therefore, the smell of breast milk can be used as a complementary method to accelerate the health promotion of premature infants.

Conventional therapies using herbal medicine to treat asthma are employed by practitioners in Iran. The use of herbal medicine for asthma is rooted in traditional knowledge. Scientific evaluation of these historical documents could be valuable to find new potential applications in conventional medicine. Traditional Persian Medicine (TPM), which is widely known with the manuscripts of Avicenna and Rhazes, is one of the most ancient medical sets of beliefs. In this study, firstly we introduce a series of medicinal plants that would be enormously valuable for treating asthma on the basis of Avicenna (The Canon of Medicine by Avicenna). After that, we review medicinal plants properties found in the pharmacological studies from electronic databases and then discuss their mechanism of action in asthma.For a detailed review, relevant abstracts and articles related to the above-mentioned areas were selected, including review articles on the subjects, along with clinical trial studies on animals and humans. The physicians of ancient Iran such as Avicenna treated asthma patients with a variety of medicinal herbs including Hyssop, Galangal, Zataria, Myrrh, Turpeth, Aristolochia, Cinnamon, Saffron, Ginger, Fennel and Anise. Some of these herbs are currently used, while others have the potential to be used in the future of asthma management. Various activities such as anti-inflammatory, bronchodilator, antitussive and etc. have been proposed by scientific studies on traditionally applied antiasthma plants. According to the reviewed studies the Hyssop, Saffron, Ginger, Anise and Fennel have the highest pharmacological effects and role in the treatment of asthma. The effectiveness of the investigated plants is, further, confirmed in recent medical studies; therefore, different components of these herbs can be investigated for being utilized in manufacturing new drugs.

The aim of this study was to investigate the effects of focusing instructions (internal and external) and attention feedback (internal and external) on learning free throwing skills of basketball in children aged 9 to 11 years.
For this purpose, 70 female students aged 9 to 11 years were selected from District 18 of Tehran and randomly divided into five groups of 14 individuals, including one Control Group (CG), along with four Experimental Groups (EGs) of Internal Attention (EG 1), External Attention (EG 2), Internal attention feedback (EG 3), and External attention feedback (EG 4). After learning some basic instructions and watching the instructional video, the pre-test was performed including a 10-item set (10 blocks). The acquisition phase consisted of two sessions on two consecutive days and each session consisted of 5 blocks of 10 attempts with two minutes of rest between the blocks. Immediate retention test was performed immediately after the acquisition phase and delayed retention test was conducted 48 hours after the last acquisition session. Data analysis was performed using repeated measures one-way Analysis of Covariance (ANCOVA), and LSD post hoc test using SPSS software version 20 and Excel at a significant level of P <0.05.
The findings revealed that both attention-grabbing methods improved children's motor functions (P <0.05). In combination of data related to internal and external attention as well as external and internal attention feedback, the findings showed that there were significant differences between the effects of interventions on children's motor skills learning, to the advantage of the external attention feedback (P <0.05).
The present findings in support of the hypothesis of limited practice in order to learn the motor skills of children's basketball free throwing, recommend the use of feedback and attention signs, especially the external ones.

Limited studies have examined the effect of reflexology on pain and fatigue in thalassemia major patients. The aim of this study was to determine the effect of foot reflexology on pain and fatigue in patients with major thalassemia.
In this double-blinded randomized controlled trial, 90 patients were assigned into 3 groups equally (reflexology, touch, and control) by the minimization method. The reflexology group received an entire foot massage three times a week, for 2 weeks, for 10-15 minutes. No intervention applied in the control group, and in touch group touching was applied with the same pattern as the intervention group. The pain and fatigue score was measured before, immediately and 2 weeks after the intervention on the NRS and FSS scales respectively. Data was analyzed by SPSS version 22, using Chi-square, Fisher Exact, Mann-Whitney U, repeated measure ANOVA tests and statistically modeling at a significance level of 0.05.
There were no significant differences between the groups regarding demographic characteristics. On the reflexology and touch group, the mean score of the pain and fatigue decreased significantly (p=0.001) both at the immediate measurement and two weeks after the intervention. In intergroup comparison, the pain score in the reflexology group was significantly lower than in the two other groups. But the fatigue scores did not make any significant changes.
Reflexology could be used safely in management of pain in major thalassemia patients; but it could not reduce the patients' fatigue.

One of the most important actions in taking care of the hospitalized children is to control their pain and anxiety. The aim of this study was to investigate the effects of a supportive program on pain and anxiety of children undergoing surgery through using distraction to educate them in different concepts (preschool educational concepts, coping skills, problem-solving techniques and life skills).

In this Quasi Experimental study, 64 3-6-years-old children admitted to Imam Hossein Children's Hospital in Isfahan were selected by convenience sampling methods and were divided into two groups (n=32). TPPS checklist and Piyeri Anxiety Inventory were used for data collection.  In order to distract the mind, a supportive intervention program was performed for the experimental group 24 hours after surgery, in a 45-minute session. Data analysis was performed using SPSS software version 21.

After the intervention, both mean scores of pain and severity of anxiety in the experimental group were significantly lower than those of the control group and also than those of the same group before the intervention (P <0.05).

The proposed supportive intervention program is an appropriate non-pharmacological method for reducing pain and anxiety that considers various aspects of children's physical, mental and emotional needs along with their evolutionary growth.

Polysomnography is a gold standard method for examination of information obtained from physiological changes in the body related to sleep. The aim of this study was to diagnose respiratory disorders in children and adolescents with sleep disorders by the use of polysomnography.
The sample of this cross-sectional retrospective study included 112 children and adolescents aged 0-18 years who were referred to the sleep ward of Qazvin children's hospital due to sleep disorders. After recording the participants’ comprehensive demographic and medical history, questionnaires regarding their sleep history were filled in by their parents. Then the results of polysomnography and severity of obstructive sleep apnea (OSA) were identified. SPSS 21 software and frequency tables were used to determine the prevalence of the variables.
The most common sleep disorder was restless sleep (68; 60.71%). One hundred and four (92.85%) patients had sleep apnea. Also, 66 (58.92%) patients with severe OSA, 19 (16.96%) patients with moderate OSA, 14 (12.5%) patients with mild OSA and 5 (4.46%) patients with central sleep apnea were observed. Eighty eight (78.57%) children had less than normal sleep efficiency (less than 90%) and 34 (30.35%) had normal and desirable sleep efficiency. Total adenotonsillectomy, medical therapy for OSA and non-invasive ventilation (NIV) were recommended for 46 (41.7%), 27 (24.10%) and 20 (17.85%) patients, respectively.
Symptoms of respiratory disorders during sleep were seen in our results, especially in children with a history of adenotonsillectomy. Based on the severity of symptoms, medication was prescribed for children. Referral of children suspected of sleep disorder to a physician is essential for control and treatment of this disease.

Pediculosis is still recognized as a worldwide infestation and is a major public health concern. The aim of this study was to determine the cognitive determinants Predicting Pediculosis Preventive Behaviors (PPB) based on the Health Belief Model (HBM).

This descriptive cross-sectional study was conducted among 193 female high school students in the west of Iran, during 2019. The participants were selected by random sampling method. They filled out a self-administered questionnaire including the Background variables, PPB questionnaire, and HBM determinants. Data were analyzed by SPSS-22 software using Pearson correlation test and linear regression analysis.

The mean age of the students was 12.72 years [SD: 0.60], ranging from 12 to 14 years.  The mean score of PPB was 7.72 [SD: 2.23], ranging from 0 to 10. HBM determinants accounted for 20% of the variation in PPB.  The best predictors of PPB were perceived susceptibility (Beta: 0.303, P<0.001), perceived barriers (Beta: -0.217, P=0.004) and perceived self-efficacy (Beta: 0.158, P=0.040), respectively.

It seems that the development and implementation of health promotion programs to increase susceptibility toward the risk of pediculosis, improve self-efficacy toward performing PPB, and reduce the barriers in adopting PPB among the students. These results may be useful in preventing pediculosis

Despite vaccination against SARS-CoV-2, the COVID-19 pandemic continues to expand worldwide. Early reports suggested that only a minor proportion of pediatric population is affected by COVID-19 in comparison to adult population. Three percent of pediatric population needed admission to intensive care units, and only a small number of deaths have been reported. Available literature suggests that infants (children under 1 year) seem to be more vulnerable to COVID-19 virus infection with a higher severity of illness compared with other pediatric ages. Requirement for neonatal mechanical ventilation is 20%–22.4% (vs. 4% in children) (1).

Mild microcytic hypochromic anemias caused by iron deficiency (IDA) and beta-thalassemia trait (β-TT) continue to be problematic and a significant threat to society, particularly in relatively poor developing countries. The goal of this study was to use an accuracy approach to improve the diagnostic function of eight different prejudiced indices in Egyptian pediatric patients with microcytic anaemia.
Eight discrimination indices for diagnostic performance are introduced to analyze the differences between β-β-TTand IDA among Egyptian paediatric patients by using evaluation metrics calculated from RBC indices by various mathematical formulae. CBC, iron study and hemoglobin electrophoresis were performed to all included participants.
A total of 300 Egyptian paediatric patients with β-TT or IDA were enrolled. The Mentzer and Ehsani index exhibited the highest diagnostic accuracy (100%) followed by Sirdah (97.5%), Sirvistava (95%), MDHL (92.5%)  Green & King, Recierca, (90%), and Matos (70%). Indices with AUCs greater than 0.8, such as Mentzer, Ehsani, and Sirdah had very valuable predictive accuracy in distinguishing between β-TT and IDA.
Although Hb electrophoresis is the gold standard for diagnosing β-TT, in developing countries, the Mentzer index, followed by the Ehsani and Sirdah indices, could be used as a simple and cheap method to distinguish β-TT from IDA in pediatric patients with mild microcytic hypochromic anaemia.

Sleep is important in promoting optimal growth, health, and well-being while providing the highest opportunity for effective functioning in children. The high prevalence of sleep problems and their negative outcomes for children and parents reflect the need to design early screening tools that parents or professionals can use to assess sleep problems in the first 3 years of life. This study aimed to assess the reliability and validity of the Persian version of the Brief Infant Sleep Questionnaire-Revised (BISQ-R).
The study used the standard method of questionnaire translation and back-translation from Persian to English. After sending the final version to the original author for approval, 10 experts evaluated the validity of the questionnaire using both quantitative and qualitative methods, and 20 parents of children commented on the reliability of the questionnaire. Twenty hospitalized children with a diagnosis of pneumonia and their mothers participated in the study.
Moderate and high correlations (0.41-0.88) and significant relationships (P<0.05) were found between the items of the pre-test and post-test questionnaires. There were no statistically significant differences (p> 0.05) between the pre-test and post-test scores of the BISQ-R instrument (paired t-test), showing similar results in two consecutive tests that confirmed the stability of BISQ-R and its test-retest reliability.
According to the results, the Persian version of the BISQ-R questionnaire has acceptable validity and reliability; therefore, this questionnaire is a valid and reliable instrument to assess children’s sleep and can be used for children aged 12 to 36 months in different environments

Dental anxiety/fear in children is a main reason for the problems in their behavior management and avoiding dental care. This study aimed to evaluate the prevalence and level of dental anxiety/fear in Iranian children and adolescents as well as its related factors.
330 children aged 7-14 participated in this study and answered the questionnaire of Children’s Fear Schedule-Dental Subscale (CFSS-DS). Data were analyzed using Chi-square and Split-half tests.
Dental anxiety prevalence was 20.6% in 7-11 year-olds and 11% in 12-14 year-olds (P=0.001). This value was 17.6% in girls and 14% in boys (P=0.01). Mean of the anxiety score was 29.3 - 7.6 in boys and 31.4 - 7.6 in girls (P=0.015). Prevalence of dental anxiety was 19.7% in the participants without previous dental experience and 8.6% in those with this experience (P=0.001). The mean anxiety score was 31.3 - 7.6 in children without previous dental experience and 28.6 - 7.3 in those with previous experience (P=0.002). The concomitant factors significantly related to high dental anxiety were injection and choking sensation.
Dental anxiety is more in girls and children without previous dental experience, and it decreases with increasing age. Injection and choking sensation are related to high dental anxiety

the present study aimed to translate the cystic fibrosis questionnaire for adolescents and adults (CFQ-R 14+) into Persian, and assess its validity and reliability.
In total, 35 patients with cystic fibrosis (CF) completed the Persian version of CFQ-R 14+, and Forced Expiratory Volume in one second (FEV1) and body mass index (BMI) were measured. In addition, the Pediatric Quality of Life inventory (PedsQL) was completed by the subjects. The validity of the CFQ-R 14+ was assessed using the face validity, Content Validity Ratio (CVR), and Content Validity Index (CVI), along with concurrent and know-group validities for checking its construct validity. The scale’s reliability was also estimated by test-retest and Cronbach's alpha coefficients.
After forward-backward translation, the values of the total CVR and CVI and their sub-items were higher than 0.8 and 0.49 respectively. Most of the scales had strong internal consistency (Cronbach's Alpha≥0.70), and the test-retest correlations were within the range of 0.72-0.95, considered significant for all the scales. Moreover, strong correlations were observed between the total CFQ-R and PedsQL 4.0 (r=0.9; P<0.001), as well as moderate-to-strong incomparable domains (r=0.4-0.8). A significant correlation was denoted between the total CFQ-R scale and FEV1 (r=0.42; P=0.01), while a reverse correlation was observed between the total CFQ-R scale and age group discrimination (r=-0.35; P=0.03).
According to the results, the Persian version of the CFQ-R 14+ is a reliable and valid instrument for measuring the health-related quality of life among Iranian adolescent and adult patients with CF.

The study compares the learning of static balance skill by observing a point-light display between children with mild mental retardation and healthy children.
The subjects are 30 children with mild mental retardation (experimental and control groups) and 30 healthy children (experimental and control groups). The motor task includes a static balance in which the length of time children could perform the skill without error was measured as a dependent variable. Subjects perform the pretest (including one trial), the acquisition phase (including five 3-minute practice blocks), and the post-test (including one trial). The children in the experimental group observed a skilled model performing static balance skills in the form of a point-light display for two minutes before performing each block.
The results show that the children with Mental Retardation who had observational practice performed better than their control group in the posttest. The results also showed that healthy children performed better than the children with mental retardation when performing static balance skills. 
Children with mild mental retardation can learn motor skills by observing a point-light display. In addition, it was revealed that healthy children perform better than children with mild mental retardation in the motor skills acquired through an observational learning process.

Considering the prevalence of diabetes in children and also the effect of good control of blood sugar and hemoglobin A1C (as a long indicator of glucose control) on reducing the complications of diabetes, this study was done to compare two glycemic control methods in children and adolescents with T1DM.
The CGM device was connected to the patients once every three months for 4 to 7 days and the number of hypoglycemic events per month and their average HbA1C and average daily dosage of insulin were collected before and after installing the CGM device. Statistical tests were performed in SPSS software.
The results showed that the use of CGM leads to more decrease in the number of hypoglycemic cases, in comparison to SMBG. The percentage change in the number of hypoglycemic cases was not statistically significant with any of the factors of the patient’s age, gender and duration of diabetes. In addition, the results showed that the use of CGM leads to a greater decrease in HbA1C levels, when compared to the SMBG.
The mentioned decrease, not related to age, sex, and duration of diabetes, might be due to the increase in patients’ insight into their disease and how to control their level of blood sugar; and on the other hand due to increase in the doctor's insight into the patient's abilities in self-monitoring blood sugar but CGM did not reduce the patients’ daily insulin dosage