Blood Glucose Self-management Research Articles

Continuous glucose monitors and virtual care in high-risk, racial and ethnic minority populations: Toward promoting health equity.

Continuous glucose monitors (CGMs) have become an important tool to aid self-management of blood glucose for many patients with diabetes in the U.S., and the benefits of CGM use are well-documented. However, disparities in CGM use exist, with lower use in certain marginalized racial and ethnic groups. CGM may be an important and underutilized tool to help reduce inequities. Evidence supporting the use of CGMs as a part of virtual care is discussed, with an emphasis on designing virtual diabetes care programs to promote health equity. Recommendations for clinical practice and research are presented. In clinical practice, CGM should be an option for all people with diabetes who qualify based on clinical practice guidelines, regardless of race, ethnicity, or other individual characteristics. Future research should characterize the use of, benefit from, and preferences for CGM among individuals from racial and ethnic groups to guide interventions at the health system, clinic, provider, and patient levels to promote equitable, evidence-based, and guideline-directed CGM use in marginalized racial and ethnic groups with diabetes.

328-OR: Evaluation of Mobile Health Technology–Based Diabetes Education System for Self-Management of Patients with Type 2 Diabetes Mellitus

Ongoing research has established that mobile health applications (apps) are feasible tools for improving self-management of diabetes and to maintain glycemic control. This single-arm, multi-center, observational study evaluated the effectiveness of an app-based diabetes education program in improving HbA1c among patients with type 2 diabetes mellitus (T2DM) treated with premixed insulin for 12 weeks. A total of 9426 patients were included. Primary endpoint was the change in HbA1c from baseline to week 12. Secondary endpoints included the association of HbA1c reduction with number of diabetes education courses completed and learning mode, and the association of SMBG frequency with diabetes education courses. According to the number of diabetes education courses completed, the patients were divided into 3 groups: 0-4 courses, 5-29 courses, and ≥30 courses. After 12 weeks of engagement in app, there was a decrease in HbA1c levels (9.84 ± 1.47 % vs. 7.36 ± 1.15 %) with 36% of patients achieving HbA1c target at week 12. The HbA1c control rate was the highest among patients completing ≥30 courses (49%; mean change: -2.9%) , followed by those who completed 5-29 courses (38%; -2.7%) and 0-4 courses (35%; -2.4%) (P<0.0001) . Besides, the frequency of SMBG testing increased with the ascending number of courses completed (≥30 courses: 7.4 times/week; 5-29 courses: 3.5 times/week; 0-4 courses: 1.2 times/week; P<0.0001) . HbA1c reduction (-2.7% vs. -2.4%; P<0.0001) and the proportion of patients with HbA1c <7% (42% vs. 35%; P<0.0001) were significantly lower in patients who preferred audio-visual learning over visual learning for diabetes course engagement. To summarize, participants who completed more diabetes education courses had better HbA1c reduction over 12 weeks and better self-management of blood glucose with the app. Disclosure C.Si: None. J.Lu: None. Y.Bao: None. J.Zhou: n/a. W.Jia: None.

The impact of new continuous glucose monitoring (CGM) devices versus self-management of blood glucose (SMBG) on the daily life of parents and children affected by type 1 diabetes mellitus

The impact of new continuous glucose monitoring (CGM) devices versus self-management of blood glucose (SMBG) on the daily life of parents and children affected by type 1 diabetes mellitus

Utilizing Technology-Enabled Intervention to Improve Blood Glucose Self-Management Outcome in Type 2 Diabetic Patients Initiated on Insulin Therapy: A Retrospective Real-World Study.

Background The aim of this study was to assess the benefits of a mobile-enabled app through Lilly Connected Care Program (LCCP) in achieving blood glucose control and adhering to self-monitoring of blood glucose in patients with type 2 diabetes mellitus (T2DM). Methods This retrospective study included T2DM patients who were initiated on insulin therapy (mostly premixed insulin) after failure to respond to oral antidiabetic drugs. Patients were provided with glucometers enabled with synchronous data transmission to healthcare providers and family members. The primary objective was to assess the benefits of LCCP based on changes in fasting blood glucose (FBG) and postprandial glucose (PPG) levels from baseline to 12 weeks. Paired t-test was used to assess the change in blood glucose (BG) from baseline to week 12. Results In total, 14,085 T2DM patients were recruited. Compared with baseline, significant reductions in FBG and PPG were evident at week 12 (FBG: -0.39 mmol/L; PPG: −0.79 mmol/L; both P < 0.001). Furthermore, at week 12, the proportion of patients attaining a target glucose level of FBG <7.0 mmol/L and PPG <10.0 mmol/L was 25.37% and 59.68%, respectively, with a statistically significant increase compared with that at baseline (6.74% and 45.59%, respectively, both P < 0.001). The frequent monitoring of patients could gain a higher target achievement of FBG (28.1% vs 24.2%) and PPG (64.4% vs 55.1%) than the occasional monitoring patients. Additionally, the incidence of hypoglycemia gradually decreased and was significantly lower than the baseline level. Conclusions In T2DM patients with poor glycemic control, the application of mobile enabled intervention (LCCP) along with insulin significantly reduced the hypoglycemia while improving glycemic control during period of naïve initiating insulin therapy. Additionally, the high frequency of BG self-monitoring was associated with better glycemic control.

The Self-Management Experiences of Adolescents with Type 1 Diabetes: A Descriptive Phenomenology Study.

Many adolescents with type 1 diabetes experience challenges in achieving good glycemic control and have insufficient understanding in executing interventions for glycemic control. This study aimed to understand self-management experiences of adolescents with type 1 diabetes in Taiwan. In this descriptive phenomenological study, we conducted in-depth interviews with 18 adolescents with type 1 diabetes from the pediatric outpatient clinic of a medical center. Data were analyzed using the Colaizzi’s method. Four themes were identified: (1) misconception regarding self-management of blood glucose; (2) conflict between depending on and breaking away from parental assistance for glycemic control; (3) encounter with disruptions in glycemic control regimen due to the presence of schedule changes; and (4) lack of motivation to achieve good glycemic control. The findings indicated that the misconceptions of adolescents with type 1 diabetes about managing glycemic levels resulted from an insufficient understanding of self-management of diabetes. In Taiwan, the heavy emphasis of academic achievement and changes of schedules during breaks tended to disrupt the regimen for glycemic control. Healthcare professionals are encouraged to provide individualized education focusing on the adolescents’ misconceptions regarding self-management of diabetes.

778-P: The Impact of Self-Management Blood Glucose (SMBG) Real-Time Decision Support on Glycemic Control in Adult with T1D in China

Objective: To assess the effect of use frequency of SMBG real-time decision support in a diabetes app on glycemic control in adult with T1D. Methods: T1D users from TangTangQuan® App meeting the following criteria will be selected: physician diagnosed T1D with aged≥18 years old, T1D duration ≥1 year. Frequency of uploading SMBG was be calculated in 2018. Patients were divided into two groups according to frequency of uploading SMBG (high engagement group (HE, ≥15 days/month; and control group&amp;lt;15 days/month). The changes in HbA1c, incidence of hyper- and hypo-glycemia from baseline to 12 months after using app were compared. Results: Of 3474 users over 1 year, 562 eligible patients had complete set of HbA1c records. At baseline, the mean age was 26.6±7.3 years, 33.5% were male, the mean HbA1c was 6.5±0.9%. Change in HbA1c from baseline improved in the HE group than that in control [-0.3 (-0.6, 0.2) vs. -0.1 (-0.8, 0.5) %, p=0.023]. Furthermore, Incidence of hyperglycemia at 12 months was significantly decrease in HE group than control, while no difference in Hypoglycemia between two groups (Table 1). Engagement intensity was significantly and independently associated with changes in HbA1c after adjustment by multiple regression analysis [-0.4 (-0.7, -0.0), p=0.036]. Conclusions: High engagement in SMBG real-time decision support may benefit for glycemic control in Chinese T1D adult. Disclosure Z. Liu: None. C. Wang: None. X. Zheng: None. S. Luo: None. D. Yang: None. J. Yan: None. J. Weng: None. Funding National Key Research and Development Program of China (2018YFC1314100)

868-P: Live Coaching Improves Glycemic Control and DSMQ Scale in People with Type 2 Diabetes

People with diabetes face numerous challenges to effective self-management of blood glucose (BG) including access to diabetes education and support. This study explores how a coaching program structured around the AADE7 Self-Care Behaviors™ and evidence-based behavior change strategies optimized for remote interaction between the coach and participant can improve glycemic control. Certified Diabetes Educator coaches used a care management platform, Welkin Health, that displays BG test results from integration with the OneTouch Reveal diabetes mobile app. Welkin supports communication methods with patients including email, SMS and telephone communication. The software platform also uses logic to prioritize patients who need attention so the coach can better manage their relationship with the participant. Adult participants with type 2 diabetes and HbA1c ≥8.0% received an AccuBase A1c mail-in test kit at baseline and weeks 12 and 24 to measure their HbA1c levels. Each participant used a OneTouch Verio Flex glucose meter connected by Bluetooth to OneTouch Reveal app. After 12 weeks (n=67), mean HbA1c declined by 0.85% from 9.19% to 8.34% (p&amp;lt;0.05) and 65% of subjects had an HbA1c decrease of &amp;gt;0.5%. After 24 weeks, mean change in HbA1c was still 0.78% less than baseline (p&amp;lt;0.05) with 51% of participants experiencing a decline of &amp;gt;0.5%. The decline in HbA1c occurred without any increase in hypoglycemic events. There was a 14.1% increase in % of results in range (p&amp;lt;0.05). Improvement in HbA1c came without any substantial change in testing frequency. In addition, there were various positive changes in the Diabetes Self-Management Questionnaire (DSMQ) scale. In conclusion, live coaching using the Welkin Patient Relationship Management technology in conjunction with the OneTouch Reveal diabetes app resulted in significant improvement in glycemic control in participants with type 2 diabetes who were in relatively poor control. Disclosure L.B. Katz: Employee; Self; LifeScan, Inc. K.D. Neland: Research Support; Self; LifeScan, Inc. D.J. Rolando: None. D.M. Shearer: None.

Self-management of type 2 diabetes mellitus utilizing technology based mobile medical assisted blood glucose management: Study protocol for a prospective, multi-center, observational study

IntroductionDiabetes mellitus is a major health concern globally as well as in China. Currently, the blood glucose (BG) control and patient outcome of diabetes are less than optimal, due to the poor adherence to established evidence-based treatment guidelines and low utilization of preventive care services by both providers and patients. Evidence suggest the benefit of mobile technology-based applications in improving BG monitoring and management in type 2 diabetes mellitus (T2DM). This study is designed to evaluate the effectiveness, safety and timeliness of the mobile internet technology in improving outpatients blood glucose self-management of Chinese T2DM. Methodsand Analysis: This is a prospective, single-arm, multi-center, observational study involving 250 hospitals across China. Patients aged ≥18 and ≤ 80 years with a diagnosis of T2DM and poor glycemic control, who were willing to receive premixed insulin analogues and could use their own WeChat account independently, were included in the study. The primary outcome of the study is to assess the benefit of programme based on change in hemoglobin A1c (HbA1c) from baseline to 3 months. Secondary outcomes included proportion of patients achieving HbA1c<7% at 3 months, change in fasting and postprandial glucose levels from baseline, incidence of hypoglycemia, frequency of self-monitoring blood glucose (SMBG), the patient behavior of BG monitoring on platform and the association of BG control with health care professionals (HCP)-patient interaction. The mobile based technology intervention can improve the HbA1c and BG levels in the patients receiving premixed insulin analogues and that the adherence of SMBG was increased and the incidence of hypoglycemia was decreased. Additionally, early detection of treatment-related hypoglycemia or other complications will contribute to timely therapeutic adjustments and lifestyle modifications under HCP's recommendations through the seamless HCP-patients interaction based on the mobile application. Ethics and disseminationThe study protocol was approved by the ethics committees from each study site according to the International Conference on Harmonization guidelines for Good Clinical Practice and conformed to Declaration of Helsinki. The results of the analyses will be shared with all the participating hospitals and will be published in peer-reviewed journals. No personal information will be included in the findings. RegistrationThis study was registered at chictr.org.cn (ChiCTR 1900021191).

Appropriateness of action prompts for hypoglycaemia and hyperglycaemia in type 2 diabetes self-management apps.

Control of blood glucose levels is needed not only to alleviate symptoms of hypoglycaemia and hyperglycaemia, but also to prevent or delay diabetes-related complications. Advice for glucose control is usually provided to patients by members of the health care team. However, many diabetes apps claim to enhance self-management of blood glucose by providing decision support to patients when an out-of-range blood glucose level is recorded. In this study, we investigated the appropriateness of action prompts provided by diabetes apps for hypoglycaemia and hyperglycaemia against evidence-based guidelines. We used methods previously reported to identify and select diabetes apps, which were downloaded and assessed against the American Diabetes Association (ADA) guidelines. Screenshots of action prompts corresponding to low or high out-of-range blood glucose values were subjected to content analysis. Of 371 diabetes self-management apps evaluated, only 217 and 216 apps alerted patients about hypoglycaemia and hyperglycaemia, respectively. Of these, 20.7% (45/217) and 15.3% (33/216) also provided action prompts. We found 5.1% of apps (hypoglycaemia: 11/217; hyperglycaemia: 11/216) provided prompts that were either too general to be helpful or not aligned with ADA guidelines. Overall, only 17.9% (39/217) and 14.8% (32/216) provided appropriate action prompts for hypoglycaemia and hyperglycaemia, respectively. Less than one fifth of apps provided evidence-based steps to guide patients through hypoglycaemia and hyperglycaemia. The majority of apps failed to provide just-in-time diabetes self-management education to prevent frequent or severe episodes of hypoglycaemia and hyperglycaemia. Our findings emphasize the need for better design and quality assurance of diabetes apps.

Uptake and use of a diabetes management program with a mobile glucometer

ObjectiveInnovative mobile health technologies (mHealth) may facilitate self-management of blood glucose. This study evaluates uptake, use, and predictors of uptake and long-term use of a diabetes mHealth intervention, which comprises an FDA-approved mobile glucometer and nurse coaching, in a real-world setting. Methodsn = 4438 commercially-insured adults with diabetes were recruited from 2014 to 2015 via an opt-in, phone-based process. In this post-only study, we obtained data on recruitment, glucometer use, demographics, and insurance and employer characteristics. We calculated percent uptake and reasons for unsuccessful recruitment. We used logistic regression to model predictors of uptake and survival analysis to examine duration of testing and predictors of discontinuation. ResultsOf the recruited members, 556 (12.5%) signed up for the mHealth program and 324 (7.3%) began testing. Of those who did not sign up, the majority (70.6%) were unable to be reached by phone. Male (OR = 1.60, 95% CI: 1.25, 2.03) and Spanish-speaking (OR = 8.34, 95% CI: 5.40, 12.88) members were more likely to start testing. Two-thirds (66.2%) of those who started testing had a first test value that indicated hyperglycemia; 97% tested more than once and the median time between first and last test was 407 days. Older age was the only significant predictor of long-term use. ConclusionsAlthough uptake of the mHealth program was low, most members who started testing had initial glucose values that indicated a need for better glucose management and the majority of patients engaged with the program for over a year. Male and Spanish-speaking members were more likely to initiate the program.

Decision Support and Alerts of Apps for Self-management of Blood Glucose for Type 2 Diabetes

In 2018, an estimated 7.8% of individuals with diabetes who owned a smartphone used a diabetes app to support self-management.1 A meta-analysis found that using an app supporting blood glucose self-management was associated with a hemoglobin A1c (HbA1c) reduction of 0.5%.2 As most diabetes apps fall outside US Food and Drug Administration regulation, intended effect and clinical safety are not ensured.3 Previous studies of diabetes apps described features, privacy and security, and usability.4 This study analyzed key management features, namely decision support and alerts for self-management of blood glucose in type 2 diabetes.

Examining Diabetes Management Apps Recommended From a Google Search: Content Analysis.

BackgroundThe availability of smartphone health apps empowers people to manage their own health. Currently, there are over 300,000 health apps available in the market targeting a variety of user needs from weight loss to management of chronic conditions, with diabetes being the most commonly targeted condition. To date, health apps largely fall outside government regulation, and there are no official guidelines to help clinicians and patients in app selection. Patients commonly resort to the internet for suggestions on which diabetes app to use.ObjectiveThe objective of this study was to investigate apps identified through a Google search and characterize these apps in terms of features that support diabetes management.MethodsWe performed a Google search for the “best diabetes apps 2017” and explored the first 4 search results. We identified and compiled a list of the apps recommended in the returned search results, which were Web articles. Information about each app was extracted from the papers and corresponding app store descriptions. We examined the apps for the following diabetes management features: medication management, blood glucose self-management, physical activity, diet and nutrition, and weight management.ResultsOverall, 26 apps were recommended in 4 papers. One app was listed in all 4 papers, and 3 apps appeared on 3 of the 4 lists. Apart from one paper, there were no explicit criteria to justify or explain the selection of apps. We found a wide variation in the type and the number of diabetes management features in the recommended apps. Five apps required payment to be used. Two-thirds of the apps had blood glucose management features, and less than half had medication management features. The most prevalent app features were nutrition or diet-related (19/24, 79%) and physical activity tracking (14/24, 58%).ConclusionsThe ambiguity of app selection and the wide variability in key features of the apps recommended for diabetes management may pose difficulties for patients when selecting the most appropriate app. It is critical to involve patients, clinicians, relevant professional bodies, and policy makers to define the key features an app should have for it to be classified as a “diabetes management” app. The lessons learned here may be extrapolated for the development and recommendation of apps for the management of other chronic conditions.

Impact of technology-based interventions for children and young people with type 1 diabetes on key diabetes self-management behaviours and prerequisites: a systematic review

BackgroundThe role of technology in the self-management of type 1 diabetes mellitus (T1DM) among children and young people is not well understood. Interventions should aim to improve key diabetes self-management behaviours (self-management of blood glucose, insulin administration, physical activity and dietary behaviours) and prerequisites (psychological outcomes and HbA1c) highlighted in the UK guidelines of the National Institute for Health and Care Excellence (NICE) for management of T1DM. The purpose was to identify evidence to assess the effectiveness of technological tools in promoting aspects of these guidelines amongst children and young people.MethodsA systematic review of English language articles was conducted using the following databases: Web of Science, PubMed, Scopus, NUSearch, SAGE Journals, SpringerLink, Google Scholar, Science Direct, Sport Discus, Embase, Psychinfo and Cochrane Trials. Search terms included paediatric, type one diabetes, technology, intervention and various synonyms. Included studies examined interventions which supplemented usual care with a health care strategy primarily delivered through a technology-based medium (e.g. mobile phone, website, activity monitor) with the aim of engaging children and young people with T1DM directly in their diabetes healthcare. Studies did not need to include a comparator condition and could be randomised, non-randomised or cohort studies but not single-case studies.ResultsOf 30 included studies (21 RCTs), the majority measured self-monitoring of blood glucose monitoring (SMBG) frequency, clinical indicators of diabetes self-management (e.g. HbA1c) and/or psychological or cognitive outcomes. The most positive findings were associated with technology-based health interventions targeting SMBG as a behavioural outcome, with some benefits found for clinical and/or psychological diabetes self-management outcomes. Technological interventions were well accepted by children and young people. For the majority of included outcomes, clinical relevance was deemed to be little or none.ConclusionsMore research is required to assess which elements of interventions are most likely to produce beneficial behavioural outcomes. To produce clinically relevant outcomes, interventions may need to be delivered for at least 1 year and should consider targeting individuals with poorly managed diabetes. It is not possible to determine the impact of technology-based interventions on insulin administration, dietary habits and/or physical activity behaviour due to lack of evidence.

Use of Color Range Indicator Technology on Point-of-Care Meters May Ease Self-Management of Blood Glucose.

The study by Grady et al is timely and exciting striving toward better understanding of relevant human factors in the design of their glucose meter displays. Their investigation focused on meaningful device optimization objectives that could be important to improving diabetes self-management. Grady et al are to be complimented for their development of a PC-based computer simulator to further our understanding of how patients interpret their glucose meter readings. What is interesting is that important, and hopefully more appropriate decisions, can be made daily or hourly when a meter is capable of displaying the most relevant information in a manner that will prompt the user toward more favorable glucose management decisions.

An On-Chip Disposable Salivary Glucose Sensor for Diabetes Control

Self-management of blood glucose (BG) is considered a norm for diabetes control. However, this invasive process is uncomfortable for patients, especially when intensive measurements with frequent finger pricks are required. Saliva, an alternative body fluid that is easily accessible and contains trace amount of glucose can be potentially used for the noninvasive monitoring of diabetes. As a solution for real-time glucose measurements using saliva for diabetic care, we have developed an on-chip disposable glucose nano-biosensor through a layer-by-layer assembly process. In this work, a clinical study of 10 healthy subjects was conducted to determine the potential usefulness of salivary glucose (SG) sensors for glycemic control. Findings revealed (1) the individual BG/SG ratio at fasting was consistent over an entire year when there was no significant change of personal health; (2) the individual SG levels tracked closely with BG levels after meals; (3) a time difference of 15-30 minutes exists between peak levels of BG and SG; (4) 2 hours after a meal, the BG/SG ratio returned to a similar value at fasting. We propose to measure fasting and pre- and 2-hour postprandial SG levels for self-management of glycemic levels. As a result, this article is not intended to replace the common BG tests. With preliminary results, we believe SG itself could be used as means for reliable diabetes monitoring and a potential fluid for prognosis of future disease.

Can an electronic glycaemic notebook associated with an insulin calculator improve HbA1c in diabetic patients on a multiple insulin injections regimen? A 26-week observational real-life study

Background: Automated insulin calculators (AICs) with carbohydrate counting (CHC) have been shown to be effective in improving glycated haemoglobin (HbA1c) levels. By contrast, use of AICs without CHC, with predetermined prandial insulin doses modified according to a correction factor and modulated as a function of glycaemia, has not yet been investigated.Methods: This comparative, retrospective, observational and non-randomized study took place over a 6-month period of routine clinical practice. It evaluated the use of Free-style InsuLinx® and Free-style Neo® Abbott Diabetes Care (AIC) in easy mode (no CHC). All patients performed a basal–prandial insulin dosing schedule, and were not educated as to how to determine carbohydrate intake. Changes in HbA1c and capillary blood glucose levels, insulin therapy, frequency of blood glucose tests and body weight were analyzed 6 months prior to inclusion (T−6), at the time of inclusion (T0) and 6 months later (T+6). From T−6 to T0 (period A), patients used a standard blood glucose meter and adjusted their insulin doses themselves, and from T0 to T+6 (period B), each patient was provided with an AIC on easy mode function.Results: Of the 230 patients, 221 were retained at the end of the study (126 type 1 diabetes mellitus (T1DM) and 95 type 2 diabetes mellitus (T2DM)).At T−6, average (±standard error of mean) HbA1c level was 8.3 ± 0.1%; T1DM: 8.5 ± 0.1% and T2DM: 8.0 ± 0.1%, respectively.At T0, the average HbA1c level was 8.4 ± 0.1% (p = 0.02); T1DM: 8.5 ± 0.1% (ns) and T2DM: 8.2 ± 0.1% (p = 0.004).At T+6, with AIC in easy mode, average HbA1c level decreased significantly to 7.7 ± 0.1% (p < 0.0001); T1DM: 8.0 ± 0.1% (p < 0.0001) and T2DM: 7.5 ± 0.1% (p < 0.0001).At T+6, in all diabetics, blood glucose monitoring frequency increased by 0.4/day (p < 0.0001). Insulin correction amounted to 14% of changes in predetermined prandial insulin doses.Conclusion: Routine clinical use of an AIC without CHC improved self-management of blood glucose and on average, decreased HbA1c levels by 0.52% in T1DM and 0.80% in T2DM after 6 months.

Exercise and Sport Participation for Individuals with Type 1 Diabetes

Exercise and Sport Participation for Individuals with Type 1 Diabetes

Use of a Data Management System to Provide Glycemic Control Instructions to Diabetic Patients Based on Patient Self-Measured Blood Glucose

To make the treatment for diabetes more effective, we assessed the effects of a data management system for glycemic control. This system enables physicians at distant medical institutions to obtain the fluctuations in blood glucose (BG) measured daily by patients themselves at home and then to give instruction for treatment based on the BG. Use of the system for 2 months resulted in decreases in the hemoglobin A1c (HbA1c) level (from 6.8% ± 0.9% to 6.6% ± 0.8% [ M ± SD], p &lt; .05) and the incidences of preprandial hypoglycemia and postprandial hyperglycemia. These effects can be concluded to have resulted from the fact that physicians become able to give patients appropriate instructions quickly. Also, these effects are considered to have resulted from patient awareness of the importance of self-management of BG.

Experience of hypoglycaemia and strategies used for its management by community-dwelling adults with diabetes mellitus: a systematic review

To synthesise the evidence on how community-dwelling adults with type 1 and type 2 diabetes mellitus experience hypoglycaemia and the strategies they use to control it. Using a three-step search strategy, all published and unpublished qualitative studies in English from January 2000 to August 2010 were retrieved. Participants diagnosed with type 1 or type 2 diabetes mellitus, experienced in self-managing their hypoglycaemia, and who lived independently in the community and attended primary care or outpatient clinics were included. An initial limited search was conducted in MEDLINE and CINAHL to identify keywords and index terms, which were then used in a second search across the CINAHL, PUBMED, SCOPUS, PsycINFO, PsycARTICLES, Web of Science, JSTOR, EMBASE and MEDNAR databases. Additionally, the reference lists of all retrieved papers were hand-searched for additional studies. Retrieved studies were assessed for methodological validity using the standardised Joanna Briggs Institute-Qualitative Assessment and Review Instrument (JBI-QARI). Data, in terms of research findings, were extracted from included studies using the standardised JBI-QARI data extraction tool. Five studies (six papers) were included in the review. The 20 findings from the six papers were grouped into three categories, which were then synthesised into one overall finding - that is 'People with diabetes mellitus can self-manage their diabetes and thus prevent hypoglycaemic episodes more effectively when health professionals provide psychological, physiological and spiritual support, and an individually targeted education programme'. Within the constraints of this review, it appears that the patient-identified priority is to maintain normality in blood glucose self-management. There is also evidence that some people lack the knowledge to identify and self-manage hypoglycaemia. To enable community-dwelling adults with diabetes mellitus to self-manage hypoglycaemia, healthcare professionals should provide individualised information and emotional support and regularly discuss and assess the person's level of knowledge, awareness of hypoglycaemia and their ability to self-manage.

Effective Use of Structured Self-Management of Blood Glucose in Type 2 Diabetes: Lessons From the STeP Study

IN BRIEF The Structured Testing Program (STeP) study used structured self-monitoring of blood glucose (SMBG) as a component of a collaborative intervention. Study results showed significant clinical, behavioral, and quality-of-life benefits from the intervention. This article discusses some of the key lessons learned from the STeP study and presents a practical approach to incorporating and utilizing structured SMBG in primary care.