Self-monitoring Of Blood Glucose Frequency Research Articles

Effects of structured testing versus routine testing of blood glucose in diabetes self-management: A randomized controlled trial

AimsTo compare the effects of structured and routine testing regimens used in self-monitoring of blood glucose (SMBG) on glycemic control and diabetes self-management in insulin-naïve type 2 diabetes patients. MethodsSixty-two outpatients with insulin-naïve type 2 diabetes were randomly allocated into two less-frequent SMBG usage groups: a structured testing group (STG) and a routine testing group (RTG). Subjects in STG measured 7-points on SMBG for 3 consecutive days once every two months without daily testing; subjects in RTG measured SMBG 3 times each week before breakfast on Monday and Friday and before dinner on Wednesday. The primary endpoint was HbA1c reduction. The secondary endpoints were change in body weight, blood pressure, treatment change, and self-management performance change. ResultsHbA1c levels were significantly decreased by 0.32% (3.50mmol/mol) in STG, partly because physicians changed medications more actively. In contrast, body weight and systolic/diastolic blood pressure were significantly reduced by 0.94kg and 6.8/4.7mmHg, respectively, in RTG, possibly related to the increased diet and exercise score in RTG. ConclusionsStructured testing without daily testing is beneficial for glycemic control; routine testing 3 times a week is more helpful for daily self-management. In low SMBG frequency usage, these two regimens can be utilized according to individual diabetic conditions.

Randomized trial of technology-assisted self-monitoring of blood glucose by low-income seniors: improved glycemic control in type 2 diabetes mellitus

Self-monitoring of blood glucose (SMBG) has been recommended for people with type 2 diabetes mellitus. This trial tested an automated self-management monitor (ASMM) that reminds patients to perform SMBG, provides feedback on results of SMBG, and action tips for improved self-management. This delayed-start trial randomized participants to using the ASMM immediately (IG), or following a delay of 6months (DG). Glycated hemoglobin (HgbA1c) level and survey data was collected at home visits every 3months. 44 diabetic men and women, mean age 70, completed the 12-month trial. Baseline HgbA1c was 8.1%±1.0, dropping to 7.3±1.0 by 9months, with a 3-month lag in the DG (F=3.56, p=0.004). Decrease in HgbA1c was significantly correlated to increased frequency of SMBG, R=0.588, p<0.01. Providing older diabetics with objective immediate contingent feedback resulted in more frequent SMBG that correlated with better glycemic control. This type of technology may provide real-time feedback not only to patient users, but to the health care system, allowing better integration of provider recommendations with patient-centered action.

Blood glucose self-monitoring and internet diabetes management on A1C outcomes in patients with type 2 diabetes

ObjectivesThe purpose of this study was to determine any correlation between frequency of self-monitoring of blood glucose (SMBG), frequency of patient-provider communication of SMBG (reporting), and hemoglobin A1C for patients...

Opportunity Cost and Policy: A Utilization Review of Self-monitoring of Blood Glucose in Manitoba, Canada

PurposeRecently, there has been a re-evaluation of the frequency, benefits, and costs associated with self-monitoring of blood glucose (SMBG). Based on little evidence of the benefit of frequent SMBG in patients with diabetes not using insulin, new guidelines and test strip limit policies have been suggested and implemented in various Canadian jurisdictions to promote a more selective practice of SMBG. The objective of this study was to assess the overall utilization and cost associated with test strips and lancets for SMBG in Manitoba from 2000 to 2013 as well as to explore the policy implications of the implementation of test strip quantity limits and its impact on overall and government costs. MethodsAn analysis of prescription claims for blood glucose test strips (BGTSs) and lancets for all patients with diabetes in Manitoba from 2000 to 2013 was conducted. In each year, patients were stratified into 4 mutually exclusive hierarchical groups according to most intensive diabetes treatment. Test strip and lancet utilization and cost were assessed for each group in each year, and the potential cost savings associated with implementation of a BGTS limit policy was projected using autoregressive integrated moving average models. FindingsIn the year 2000, 8 million test strips were dispensed in Manitoba, increasing by 170% to 21.7 million test strips in 2013. Insulin users accounted for the majority of test strip use. However, based on potential implementation of test strip limit policies, 95% of the reduction of test strip use is predicted to occur in the groups not using insulin. Based on current trends, the 5-year predicted additional cost associated with not implementing a test strip limit policy similar to that implemented in other Canadian provinces was estimated to be a total of $12.35 million. ImplicationsImplementation of the guideline-based policy limits is predicted to produce considerable savings, with 95% of potential savings occurring in patients not using insulin. There is, therefore, a significant opportunity cost associated with not implementing a policy to reduce BGTS utilization by patients with diabetes in Manitoba. Based on the lack of evidence to suggest significant outcome improvements with long-term frequent SMBG by patients not using insulin, more selective use of test strips for SMBG could allow for significant cost savings that could be redirected to other programs and interventions for the growing population of patients with diabetes in Manitoba.

Does self-efficacy mediate the cross-sectional relationship between perceived quality of health care and self-management of diabetes? Results from Diabetes MILES – Australia

Objective: Quality of health care (QoC) and self-efficacy may affect self-management of diabetes, but such effects are not well understood. We examined the indirect role of diabetes-specific self-efficacy (DSE) and generalised self-efficacy (GSE) in mediating the cross-sectional relationship between self-reported QoC and diabetes self-management.Design: Diabetes MILES–Australia was a national survey of 3,338 adults with diabetes. We analysed data from 1,624 respondents (age: M = 52.1, SD = 13.9) with type 1 (T1D; n = 680) or type 2 diabetes (T2D; n = 944), who responded to a version of the survey containing key measures.Main Outcome Measures: self-reported healthy eating, physical activity, self-monitoring of blood glucose frequency, HbA1c, medication/insulin adherence.Results: We used Preacher and Hayes’ bootstrapping method, controlling for age, gender and diabetes duration, to test mediation of DSE and GSE on the relationship of QoC with each self-management variable. We found statistically significant but trivial mediation effects of DSE and of GSE on most, but not all, variables (all effect sizes < .06).Conclusion: Support for mediation was weak, suggesting that relationships amongst these variables are small and that future research might explore other aspects of self-management in diabetes.

Predictors of hypoglycemia in insulin-treated patients with type 2 diabetes mellitus in Basrah.

AIMTo measure the incidence and determinants (predictors) of hypoglycemia among patients with type 2 diabetes mellitus (T2DM) who were on insulin treatment for at least one year.METHODSThe present study is an out-patients based inquiry about the risk and predictors of hypoglycemia among patients with T2DM seeking care at the Al-Faiha Specialized Diabetes, Endocrine, and Metabolism Center, in Basrah over a period of 7 mo (from 15th of April, 2013 to 15th of October, 2013). The data used in the study were based on all detailed interview and selected laboratory investigations. A total of 336 patients could be included in the study.RESULTSThe incidence of overall hypoglycemia among the studied patients was 75.3% within the last 3 mo preceding the interview. The incidence of hypoglycemia subtypes were 10.2% for severe hypoglycemia requiring medical assistance in the hospital, 44.36% for severe hypoglycemia treated at home by family; this includes both confirmed severe hypoglycemia with an incidence rate of 14.6% and unconfirmed severe hypoglycemia for which incidence rate was 29.76%. Regarding mild self-treated hypoglycemia, the incidence of confirmed mild hypoglycemia was 21.42%, for unconfirmed mild hypoglycemia the incidence rate was 50.0% and for total mild hypoglycemia, the incidence rate was 71.42%. The most important predictors of hypoglycemia were a peripheral residence, increasing knowledge of hypoglycemia symptoms, in availability and increasing frequency of self-monitoring blood glucose, the presence of peripheral neuropathy, higher diastolic blood pressure, and lower Hemoglobin A1c.CONCLUSIONHypoglycemia is very common among insulin-treated patients with T2DM in Basrah. It was possible to identify some important predictors of hypoglycemia.

Self-monitoring of Blood Glucose (SMBG): Cornerstone of Diabetes Management- Bangladesh Perspective: A Recommendation

SMBG is a crucial factor in diabetes management. It offersa quick check of glycemic status, helps to identify hypoglycemia and hyperglycemia. In addition SMBG assists in clinical decision making and as such it complements HbA1c. But due to many reasons SMBG is not practiced properly and adequately. In recent years several international guidelines higllighted the importance of SMBG for diabetes management. Very few diabetic patients in Bangladesh actually perform SMBG regularly at home. The awareness of the benefits of SMBG is also low. There is no uniformity in SMBG practice among the patients as there is no local guideline to help the physicians in determining the optimum SMBG frequency for their patients. So a working guideline on SMBG is the call of the day. This article is an attempt in that direction. Exploring international guidelines and evaluating their applicability in local context a number of recommendations have been proposed.J Bangladesh Coll Phys Surg 2014; 32: 218-223

Once Daily Self-Monitoring of Blood Glucose (SMBG) Improves Glycemic Control in Oral Hypoglycemic Agents (OHA)-Treated Diabetes: SMBG-OHA Follow-Up Study.

The aim of this study was to compare glycemic control between SMBG-continued and -discontinued subjects with type 2 diabetes in the SMBG-OHA study. Of the 96 subjects from the SMBG-OHA study, 59 were recruited for the 24-week, comparison follow-up study. The study outcomes were the differences in change in HbA1c levels at 24 weeks between the 2 groups, and change in SMBG frequency in SMBG-continued subjects. Although health insurance does not cover the cost of SMBG, 22.0% of subjects continued SMBG of their own will after the SMBG-OHA study was completed. HbA1c levels were maintained from 6.81 ± 0.55% to 6.64 ± 0.53% in SMBG-continued subjects. Conversely, HbA1c levels were increased from 7.18 ± 0.63% to 7.48 ± 0.84% in SMBG-discontinued subjects. HbA1c levels were significantly different by 0.83 ± 0.25% (95% CI: -1.33 to -0.36). The difference in change in HbA1c between the groups was -0.46% (95% CI: -0.78 to -0.15). SMBG frequency was decreased from 2.02 ± 1.06 to 1.53 ± 0.86 times a day. HbA1c levels were maintained in SMBG-continued subjects but increased in SMBG-discontinued subjects. The study implied that almost once daily SMBG is helpful to maintain glycemic control in non-insulin-treated type 2 diabetes.

Self-monitoring of blood glucose measurements and glycaemic control in a managed care paediatric type 1 diabetes practice.

Intensive diabetes management requires intensive insulin treatment and self-monitoring of blood glucose (SMBG) measurements to obtain immediate information on the status of the blood glucose level and to obtain data for pattern analysis on which meal planning, insulin and lifestyle adjustments can be made. The value and optimal frequency of SMBGs are often questioned. To document the relationship between SMBG frequency and glycaemic control in a managed care paediatric type 1 diabetes practice. A retrospective analysis was performed on 141 managed care paediatric and adolescent patients over a 1-year period from 1 February 2010 to 30 January 2011. The patients were stratified according to their insulin regimen, frequency of SMBG was analysed, and glycaemic control was measured by glycated haemoglobin (HbA1c). The records of 141 paediatric and adolescent children aged 2 - 18 years were examined. A highly significant decrease (p<0.0001) in HbA1c was found when moving from two injections per day to three- and five-injection regimens. The average HbA1c and its variability reduced as the diabetes regimen became more intensive. A highly significant decrease (p<0.001) in HbA1c levels was detected as the frequency of SMBG increased, with an average decrease of 0.19% in HbA1c per unit increase in the number of SMBG measurements performed per day. The modal frequency of five SMBG measurements per day was required to achieve the American Diabetes Association and International Society for Pediatric and Adolescent Diabetes guideline recommended target HbA1c of <7.5% for a paediatric population. A beneficial relationship exists between frequency of SMBG and lower HbA1c in paediatric patients with type 1 diabetes.

Impact of Frequent and Persistent Use of Continuous Glucose Monitoring (CGM) on Hypoglycemia Fear, Frequency of Emergency Medical Treatment, and SMBG Frequency After One Year.

We assessed the impact of "almost daily" use of continuous glucose monitoring (CGM) in adults with type 1 diabetes who had at least 1 year of CGM experience. In this single-center survey, we utilized a 16-item questionnaire to assess changes hypoglycemia fear, incidence of emergency medical treatment and utilization of self-monitoring of blood glucose (SMBG) before and after 1 year of CGM use. Participation was restricted to individuals who used the same brand of CGM system to avoid confounding responses due to differences between commercial devices. Participants were recruited on an "as-seen" basis from a major, urban internal medicine clinic and associated diabetes education center. The questionnaire was completed during the clinic visit. Responses to the survey were analyzed by standard descriptive statistics. Seventy-four patients completed the survey: 42.9 years (range: 23-71 years), 38 (51%) female, 59 current insulin pump users. Most (84%) reported wearing their devices "almost daily" (n = 58) or 3 weeks per month (n = 4). "Almost daily" users reported an 86% reduction in incidence of emergency medical treatment events (P = .0013) and >50% reduction in daily SMBG frequency (P < .0001). Reductions in hypoglycemia fear were apparent but not statistically significant (P = .7359). "Almost daily" use of CGM with the Dexcom G4 system reduced incidence of emergency treatment events and daily SMBG utilization among survey respondents and a trend toward reduced hypoglycemia fear. This may indicate cost savings in reduction of emergency medical intervention and likely improved quality of life without increasing safety concerns related to hypoglycemia.

Testing for rewards: a pilot study to improve type 1 diabetes management in adolescents.

OBJECTIVETo evaluate the effectiveness of monetary reinforcement to increase the frequency of self-monitoring blood glucose (SMBG).RESEARCH DESIGN AND METHODSTen adolescents with poorly controlled diabetes enrolled in a 12-week program in which they earned monetary reinforcers based on SMBG frequency ($0.10 per test, with bonuses for ≥4 tests per day, and $251.40 maximum).RESULTSSMBG increased from 1.8 ± 1.0 to 4.9 ± 1.0 tests per day (P < 0.001) with 90% completing four or more tests per day. Mean A1C fell from 9.3 ± 0.9% to 8.4 ± 1.5% (P = 0.05). Adolescents and parents reported high satisfaction with procedures.CONCLUSIONSReinforcing adolescents for SMBG may increase testing and improve A1C.

The relationship between the frequency of self-monitoring of blood glucose and glycemic control in patients with type1 diabetes mellitus on continuous subcutaneous insulin infusion or on multiple daily injections.

Aims/IntroductionWe investigated the relationship between the frequency of self-monitoring of blood glucose (SMBG) and glycemic control in type 1 diabetes mellitus patients on continuous subcutaneous insulin infusion (CSII) or on multiple daily injections (MDI) using data management software.Materials and MethodsWe recruited 148 adult type 1 diabetes mellitus patients (CSII n = 42, MDI n = 106) and downloaded their SMBG records to the MEQNET™ SMBG Viewer software (Arkray Inc., Kyoto, Japan). The association between the SMBG frequency and the patients' hemoglobin A1c (HbA1c) levels was analyzed using the χ2-test and linear regression analysis was carried out to clarify their relationship.ResultsThe odds ratio of achieving a target HbA1c level of <8% (63.9 mmol/mol) was significantly higher in subjects with SMBG frequencies of ≥3.5 times/day compared with those with SMBG frequencies of <3.5 times/day in the CSII group (odds ratio 7.00, 95% confidence interval 1.72–28.54), but not in the MDI group (odds ratio 1.35, 95% CI 0.62–2.93). A significant correlation between SMBG frequency and the HbA1c level was detected in the CSII group (HbA1c [%] = –0.24 × SMBG frequency [times/day] + 8.60 [HbA1c {mmol/L} = –2.61 × SMBG frequency {times/day} + 70.5], [r = –0.384, P = 0.012]), but not in the MDI group.ConclusionsA SMBG frequency of <3.5 times per day appeared to be a risk factor for poor glycemic control (HbA1c ≥8%) in type 1 diabetes mellitus patients on CSII.

The Effects of a Mobile Phone Application on Quality of Life in Patients With Type 1 Diabetes Mellitus: A Randomized Controlled Trial.

The combination of an increasing prevalence of diabetes mellitus and more people having access to smartphones creates opportunities for patient care. This study aims to investigate whether the use of the Diabetes Under Control (DBEES) mobile phone application, a digital diabetes diary, results in a change in quality of life for patients with type 1 diabetes mellitus (T1DM) compared with the standard paper diary. In this randomized controlled open-label trial, 63 patients with T1DM having access to a smartphone were assigned to the intervention group using the DBEES application (n = 31) or the control group using the standard paper diary (n = 32). Primary outcome was the change in quality of life, as measured by the RAND-36 questionnaire, between both groups. Secondary outcomes included diabetes-related distress (PAID), HbA1c, frequency of self-monitoring blood glucose, and the usability of the diabetes application (SUS). Patients had a median age (IQR) of 33 (21) years, diabetes duration of 17 (16) years, and an HbA1c of 62 ± 16 mmol/mol. No significant differences in the QOL, using the RAND-36, within and between both groups were observed after 3 months. Glycemic control, diabetes-related emotional distress, and frequency of self-monitoring of blood glucose remained within and between groups. Users reviewed the usability of DBEES with a 72 ± 20, on a range of 0-100. The use of the DBEES application in the management of patients with T1DM for 3 months yields no alterations in quality of life compared to the standard paper diary.

Frequency of self-monitoring blood glucose and attainment of HbA1c target values.

Test strips for self-monitoring of blood glucose (SMBG) represent in Argentina, around 50% of diabetes treatment cost; the frequency of their use is closely associated with hyperglycemia treatment. However, the favorable impact of SMBG on attainment of HbA1c goal in different treatment conditions remains controversial. We therefore attempted to estimate the relationship between use of SMBG test strips and degree of attainment of metabolic control in an institution of our social security subsector (SSS) in which provision is fully covered and submitted to a regular audit system. Observational retrospective study using information of 657 patients with T2DM (period 2009-2010) from the database of the Diabetes and Other Cardiovascular Risk Factors Program (DICARO) of one institution of our SSS. DICARO provides-with an audit system-100% coverage for all drugs and keeps records of clinical, metabolic and treatment data from every patient. The average monthly test strips/patient used for SMBG increased as a function of treatment intensification: Monotherapy with oral antidiabetic drugs (OAD)<combined OAD therapy<insulin treatment. In every condition, the number was larger in people with target HbA1c levels. Test strips represented the larger percentage of total prescription cost. In our population, the type of hyperglycemia treatment was the main driver of test strip use for SMBG; in every condition tested, targeted HbA1c values were associated with greater strip use. Patient education and prescription audit may optimize its use and treatment outcomes.

Glycaemic control and self-management behaviours in Type 2 diabetes: results from a 1-year longitudinal cohort study.

To better understand the associations between changes in self-management behaviours and glycaemic control. We conducted a prospective observational study of 295 adult patients with Type 2 diabetes evaluated at baseline, 6 and 12months. Four self-management behaviours were evaluated using the Summary of Diabetes Self-Care Activities instrument, which assesses healthy diet, physical activity, medication taking and self-monitoring of blood glucose. Using hierarchical linear regression models, we tested whether changes in self-management behaviours were associated with short-term (6-month) or long-term (12-month) changes in glycaemic control, after controlling for demographic and clinical characteristics. Improved diet was associated with a decrease in HbA1c level, both at 6 and 12months. Improved medication taking was associated with short-term improvement in glycaemic control, while increased self-monitoring of blood glucose frequency was associated with a 12-month improvement in HbA1c . Completely stopping exercise after being physically active at baseline was associated with a rise in HbA1c level at 6-month follow-up. Interaction analysis indicated that a healthy diet benefitted all participant subgroups, but that medication taking was associated with glycaemic control only for participants living in poverty and more strongly for those with lower educational levels. Finally, a higher self-monitoring of blood glucose frequency was associated with better glycaemic control only in insulin-treated participants. Even after adjusting for potential confounders (including baseline HbA1c ), increased frequency of healthy diet, medication taking and self-monitoring of blood glucose were associated with improved HbA1c levels. These self-management behaviours should be regularly monitored to identify patients at risk of deterioration in glycaemic control. Barriers to optimum self-management should be removed, particularly among socio-economically disadvantaged populations.

The relationship between self-monitoring of blood glucose and glycaemic control among patients attending an urban diabetes clinic in Nigeria.

Self-monitoring of blood glucose (SMBG) is a component of modern diabetes mellitus (DM) self-management. Its value is discussed controversially, and its impact in resource poor settings has been infrequently studied. The aim of this report is to determine the pattern of SMBG and its relationship with glycemic control amongst type 2 DM (T2DM) patients attending an urban DM clinic in Lagos, Nigeria. Data were collected from patients with T2DM in a cross-sectional study, using systematic random sampling, with an interviewer-administered questionnaire investigating demographic data, DM history and SMBG practice. Weight, height, fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) were measured. One hundred patients were studied consisted of 62 (62%) females and 38 (38%) males. The mean age, body mass index and HbA1c of the study population were 59.9 (9.5) years, 26.2 (5.6) kg/m2 and 7.9 (2.2%). The median (interquartile range [IQR]) FPG and duration of DM were 107.0 (82.0-142.0) and 8.5 (5.0-15.0) years respectively. SMBG was practiced by 40 (40.0%) patients with a median (IQR) of 6 (4-15) times/month. SMBG was performed more frequently by persons with tertiary level of education (P = 0.04) and DM duration ≥ 8.5 years (P = 0.04). The mean HbA1c in the group who practiced SMBG was lower though not statistically significant compared to the group that did not (7.8% vs. 8.0%, P = 0.61) practiced. The Spearman's rank correlation coefficient between the frequency of SMBG and HbA1c was -0.025, and P = 0.81 among the entire T2DM patients. There was no statistically significant relationship between SMBG and glycemic control. There is a need for larger studies to be carried out in order to justify the value of SMBG in resource poor settings.

Relationship between self-monitoring of blood glucose and glycaemic control among patients attending a specialist diabetes clinic in Jamaica

Self-monitoring of blood glucose (SMBG) is recommended as an integral part of diabetes management. This study aimed to estimate the frequency of SMBG among patients attending a specialist diabetes clinic in Jamaica and to evaluate whether SMBG was associated with better glycaemic control. This cross-sectional study analyzed data from 188 patients, randomly selected from the University Hospital of the West Indies (UHWI) Diabetes Clinic. Self-reported data on blood glucose testing was obtained by a structured interviewer-administered questionnaire. Haemoglobin A1c (HbA1c) was measured from a capillary blood sample. Linear and logistic regression analyses were used to determine the relationship between SMBG and glycaemic control. Among 188 participants (145 females, 43 males, mean age 56 ± 15 years), 60 % (95%CI 52–67 %) performed SMBG. Thirty-one percent of participants monitored their blood glucose at least once daily. Participants less than 40 years old, persons with post-secondary education and those taking insulin were more likely to perform SMBG. Multivariable linear regression showed that performing SMBG was associated with a lower HbA1c after adjusting for age, sex and insulin use (β = −0.102), p = 0.004). In multivariable logistic regression models adjusted for the same variables, SMBG was also associated with lower odds of having poor glycemic control [HbA1c >9 %], OR 0.20, p < 0.001. This study shows that SMBG is associated with lower HbA1c and decreased odds of poor glycaemic control.

Use of an Insulin Bolus Advisor Facilitates Earlier and More Frequent Changes in Insulin Therapy Parameters in Suboptimally Controlled Patients with Diabetes Treated with Multiple Daily Insulin Injection Therapy: Results of the ABACUS Trial

We assessed the impact of using an automated bolus advisor integrated into a blood glucose meter on the timing and frequency of adjusting insulin therapy parameter settings and whether the availability of this technology would increase blood glucose test strip utilization in diabetes patients treated with multiple daily insulin injection (MDI) therapy. The Automated Bolus Advisor Control and Usability Study (ABACUS) trial, a 26-week, prospective, randomized, controlled, multinational study that enrolled 218 type 1 and type 2 diabetes patients, demonstrated that use of an automated insulin bolus advisor helps improve glycemic control in suboptimally controlled, MDI-treated patients. Patient data were assessed to determine when and how often changes in insulin parameter settings occurred during the study. Patient meters were downloaded to determine blood glucose monitoring frequency. One hundred ninety-three patients completed the study: 93 control arm (CNL) and 100 intervention (experimental) arm (EXP). Significantly more EXP (47.5%) than CNL (30.7%) patients received one or more changes in their insulin sensitivity factor (ISF) settings during the study (P=0.0191). Changes in ISF settings occurred earlier and more frequently in EXP than CNL patients throughout the study. A similar trend was seen in changes in insulin-to-carbohydrate ratios. There were no differences in daily self-monitoring of blood glucose frequency [mean (SD)] between CNL and EXP patients: 4.7 (1.5) versus 4.6 (1.3) (P=0.4085). Use of an automated bolus advisor was associated with earlier, more frequent changes in key insulin parameters, which may have contributed to subsequent improvements in glycemic control but without increased glucose test strip utilization.

The impact of intervention with "Insulin Therapy Management Unit" program in poorly controlled type 2 diabetes in a community of Shanghai

Objective To assess the impact of intervention with therapy management unit program in the poorly controlled type 2 diabetic patients in a community of Shanghai.Methods There were 55 patients with type 2 diabetes with poorly controlled hyperglycemia (HbA1C ≥ 8％) enrolled in this study.They were divided at random into 2 groups:intensive care group and standard care group.The subjects in intensive care group were provided with a glucose meter and required to monitor their blood glucose levels at least 2 or 3 times per day.Community health provider acquired information of blood glucose level,episodes of hypoglycemia,and dosage of insulin every week by cell phone.Standard care patients received diabetes care from the same provider in outpatient clinic every month.Results By the end of 6 months of intervention,the intensive care group showed a significant difference in HbA1C as compared to the standard care group (7.40％ ±0.91％ vs 8.65 ％ ± 1.28％,P＜0.01).The frequency of self-monitoring of blood glucose (SMBG) was 4 times per month in both groups at baseline.After intervention,the frequency of SMBG in intensive care group was greatly increased compared to standard care group (50times per month vs 5 times per month,P＜0.01).The frequency of self-reported hypoglycemia in intensive care group was increased compared to standard care group (3 times per month vs once per month,P＜0.01).The average daily dose of insulin in intensive care group was increased 6 units by the end of the present study(P＞0.05).Conclusion After 6 months of intervention,the glycemic control was obviously improved in type 2 diabetic patients treated with insulin and the daily dose of insulin was not increased significantly.The Insulin therapy management unit is effective and safe. Key words: Diabetes mellitus ; Insulin ; Hypoglycemia ; Self-monitoring of blood glucose ; Community health services

Internet-based mentoring program for patients with type 1 diabetes.

Regardless of the type of diabetes, lifestyle modifications is an essential component of diabetes management in patients with diabetes. Maintenance of self-care behavior, including dietary habits, physical activity frequency, and self-monitoring of blood glucose (SMBG), should be started with structured diabetes education. Diabetes Self Management Education (DSME) improves metabolic control, prevents and manages complications, and maximises quality of life in a cost-effective manner [1,2]. For this reason, clinical practice guidelines on diabetes recommend that DSME must be delivered by a certified educator who has received professional training or a multidisciplinary care team [3,4]. In addition, diabetes is typically a progressive chronic metabolic disease, and chronic illnesses are usually emotionally stressful, leading to both physical and psychological fatigue [5]. Also, changing the patients' daily routines or modifying their lifestyles are not so easy, especially due to the adherence to their current habits that have lasted for a longtime. Even those that generally have self-caring behaviors are under the constant threat of severe and devastating diabetic complications or bothersome symptoms throughout their lives [5,6]. Therefore, to maintain the patients' self-care behavior, the diabetes educators need to take into account various social, emotional, and psychological factors in addition to the patients' clinical situation. Consequently, close monitoring of their adherence to previous habits, emotional support, and regular reinforcement is essential to help patients change their lifestyle and maintain it during their lifetime. To do this, a web-based telemedicine system is a good alternative strategy to guide patients with diabetes. Undoubtedly, telemedicine delivered by health care professionals is cost-effective, time-saving, convenient, and easily accessible. Especially in Korea, more than 40 million people use internet access, corresponding to about 82.5% of the Korean population [7]. Also, telemedicine has a substantial benefit for patients in the sense that it provides more individualized recommendations in real-time. Suh et al. [8] have recently reported a 12-week internet-based mentoring program for patients with type 1 diabetes whose glycemic control status were inadequate. Using the web-based mentoring protocol, 5 volunteer mentors guided 26 patients regarding appropriate insulin dosing, physical activity, and food intake within 48 hours of mentees' request. Mentors were either patients themselves or a parent of one who already had experiences in diabetes management, not professional health care providers or doctors. Unfortunately, in contrast to our expectation, their glycemic control status (HbA1c) with glucose fluctuation (Average daily risk range), number of hypoglycemic episodes, and quality of life measured by Audit of Diabetes Dependent Quality of Life and Diabetes Treatment Satisfaction Questionnaire score were not improved after the mentoring program. However, they found that the mentoring program increased the frequency of SMBG. Considering their study conditions, such as long diabetes duration (about 6 years), young-aged adult (about 32 year-old) subjects, small study number, and short observation period, we believe that emotional or psychosocial support with positive feedback were helpful in motivating patients to familiarize with SMBG. We think that the ideal role and personal qualification of the mentors were the most important factors of this mentoring program for clinical application. Because the mentors had direct influence on patients' life and glycemic control, and they were not healthcare professionals, we suggest that the role of mentors to be confined to encouraging the patients to maintain their healthcare behaviors and provide correct information and skills that will change the patients' lifestyle. In addition, the mentors should take structured diabetes educations, especially regarding insulin dosage adjustment schedule. We also believe that increased frequency of SBMG could lead to clinical benefits. It has been proven that a higher frequency of SMBG was associated with better metabolic control among subjects who were able to adjust insulin doses. At the same time, a SMBG frequency over 1 time per day was significantly related to higher levels of distress, worries, and depressive symptoms in non-insulin-treated patients [9]. Therefore, we must consider the appropriate frequency of SMBG suggested by mentors according to individual clinical circumstances, such as stable glycemic status, sick day, and so forth. A recent study has shown that diabetes-related stress is significantly correlated with a longer diabetic duration and uncontrolled glycemic status [6,10]. Therefore, we think that the internet-based mentoring program would be beneficial for patients with type 1 diabetes, especially for those with longer diabetes duration or diabetic complications, in maximising the effectiveness of diabetes education. In conclusion, well-qualified, experienced, and trained mentors seem to be helpful for both the healthcare of patients with diabetes and healthcare providers.