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Michael TJF, Wright DFB, Chan JS, Coleshill MJ, Aslani P, Hughes DA, Day RO, Stocker SL. Patient-Led Urate Self-Monitoring to Improve Clinical Outcomes in People With Gout: A Feasibility Study. ACR Open Rheumatol 2024. [PMID: 38591107 DOI: 10.1002/acr2.11666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/30/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE Self-monitored point-of-care urate-measuring devices are an underexplored strategy to improve adherence to urate-lowering therapy and clinical outcomes in gout. This study observed patient-led urate self-monitoring practice and assessed its influence on allopurinol adherence, urate control, and health-related quality of life. METHODS People with gout (n = 31) and prescribed allopurinol self-monitored their urate concentrations (HumaSens2.0plus) at baseline and thereafter monthly for 12 months (3 months per quarter). Adherence to allopurinol was measured using medication event monitoring technology (Medication Event Monitoring System cap). Time spent below the target urate concentration (<0.36 mmol/L) was determined. Health-related quality of life was measured using a survey (EuroQoL EQ-5D-5L). Gout flares were recorded. Two-tailed Spearman correlation and the Wilcoxon matched-pairs signed-rank test (P < 0.05) were used for statistical comparisons. RESULTS Most participants were male (94%) and had urate concentrations below the target (74%) at baseline. Overall, seven participants demonstrated repeated periods of "missed doses" (two or fewer allopurinol doses missed consecutively) and "drug holidays" (three or more missed doses). Most participants (94%) persisted with allopurinol. Time spent within the target urate concentration increased 1.3-fold (from 79% to 100%; P = 0.346), and the incidence of gout flares decreased 1.6-fold (from 8 to 5; P = 0.25) in the final quarter compared to that in the first quarter of the study. Health-related quality of life was reduced for participants reporting at least one gout flare (median utility values 0.9309 vs 0.9563, P = 0.04). CONCLUSION Patient-led urate self-monitoring may support the maintenance of allopurinol adherence and improve urate control, thus reducing the incidence of gout flares. Further research on patient-led urate self-monitoring in a randomized controlled study is warranted.
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Affiliation(s)
- Toni J F Michael
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | | | - Jian S Chan
- St. Vincent's Clinical Campus, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Matthew J Coleshill
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, Australia
| | - Parisa Aslani
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Dyfrig A Hughes
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Richard O Day
- St. Vincent's Clinical Campus, Faculty of Medicine, University of New South Wales, Sydney, Australia, and Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Darlinghurst, Australia
| | - Sophie L Stocker
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia, and Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Darlinghurst, Australia
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de Wit M, van Raalte DH, van den Berg K, Racca C, Muijs LT, Lutgers HL, Siegelaar SE, Serné E, Snoek FJ. Glucose variability and mood in people with type 1 diabetes using ecological momentary assessment. J Psychosom Res 2023; 173:111477. [PMID: 37643560 DOI: 10.1016/j.jpsychores.2023.111477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Mood fluctuations related to blood glucose excursions are a commonly reported source of diabetes-distress, but research is scarce. We aimed to assess the relationship between real-time glucose variability and mood in adults with type 1 diabetes (T1D) using ecological momentary assessments. METHODS In this prospective observational study, participants wore a masked continuous glucose monitor and received prompts on their smartphone 6 times a day to answer questions about their current mood (Profile Of Mood States (POMS)-SF (dimensions: Anxiety, Depressive symptoms, Anger, Fatigue, Vigor)) for 14 days. Mixed model analyses examined associations over time between daily Coefficient of Variation (CV) of blood glucose and mean and variability (CV) of POMS scores. Further, within-person differences in sleep and nocturnal hypoglycemia were explored. RESULTS 18 people with T1D (10 female, mean age 44.3 years) participated. A total of 264 out of 367 days (70.2%) could be included in the analyses. No overall significant associations were found between CV of blood glucose and mean and CV of POMS scores, however, nocturnal hypoglycemia moderated the associations between CV of blood glucose and POMS scales (mean Fatigue Estimate 1.998, p < .006, mean Vigor Estimate -3.308, p < .001; CV Anger Estimate 0.731p = 0.02, CV Vigor Estimate -0.525, p = .006). CONCLUSION We found no overall relationship between real-time glycemic variability and mood per day. Further research into within-person differences such as sleep and nocturnal hypoglycemia is warranted.
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Affiliation(s)
- Maartje de Wit
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Medical Psychology, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands.
| | - Daniël H van Raalte
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Endocrinology and Metabolism, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Vasculair Medicine, de Boelelaan 1117, Amsterdam, the Netherlands; Diabetes Center Amsterdam UMC, location Vrije Universiteit Amsterdam, Vasculair Medicine, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Cardiovasculair Science, Amsterdam, the Netherlands
| | - Kirsten van den Berg
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Medical Psychology, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
| | - Catherina Racca
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Endocrinology and Metabolism, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Linda T Muijs
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Medical Psychology, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
| | - Helen L Lutgers
- Medical Center Leeuwarden, Department of Internal Medicine, Leeuwarden, the Netherlands
| | - Sarah E Siegelaar
- Amsterdam UMC, location University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, the Netherlands
| | - Erik Serné
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Endocrinology and Metabolism, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Vasculair Medicine, de Boelelaan 1117, Amsterdam, the Netherlands; Diabetes Center Amsterdam UMC, location Vrije Universiteit Amsterdam, Vasculair Medicine, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Cardiovasculair Science, Amsterdam, the Netherlands
| | - Frank J Snoek
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Medical Psychology, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
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Psychological problems related to capillary blood glucose testing and insulin injection among diabetes patients. FRONTIERS OF NURSING 2020. [DOI: 10.2478/fon-2020-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Objective
This review is aimed at explaining the psychological problems related to capillary blood glucose (CBG) testing and insulin injection, as well as recommending essential strategies to solve the fear thereof.
Methods
Databases, including PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, and Google Scholar, were searched to extract the relevant articles. Initially, the terms used to retrieve related studies were “fear of blood glucose monitoring”, “anxiety capillary blood glucose testing and insulin injection”, “psychological problems on blood glucose monitoring and insulin injection”, “diabetes management”, and “diabetes mellitus”.
Results
Results showed that the psychological problems related to CBG testing and insulin injection were associated with the stress and depression experienced during diabetes self-monitoring of blood glucose. This psychological issue has its impacts such as nonadherence to medication as well as a lack of self-discipline in terms of CBG testing and insulin injection. Inadequate information, inappropriate perception, and pain/discomfort during pricking of fingers were the main reasons for the psychological issues in CBG testing and self-injection of insulin.
Conclusions
The expected benefits of this review include the explanation of the issues related to the psychological problems in CBG testing and insulin injection among type 2 diabetes mellitus (T2DM) patients. This review article also provides the recommendations on providing counseling and empowering the patients on CBG monitoring and insulin injection. Moreover, family members should provide psychological support to reduce fear, anxiety, and distress arising from CBG testing and insulin injection.
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Mogre V, Abanga ZO, Tzelepis F, Johnson NA, Paul C. Adherence to and factors associated with self-care behaviours in type 2 diabetes patients in Ghana. BMC Endocr Disord 2017; 17:20. [PMID: 28340613 PMCID: PMC5366118 DOI: 10.1186/s12902-017-0169-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 03/18/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Previous research has failed to examine more than one self-care behaviour in type 2 diabetes patients in Ghana. The purpose of this study is to investigate adult Ghanaian type 2 diabetes patients' adherence to four self-care activities: diet (general and specific), exercise, self-monitoring of blood glucose (SMBG) and foot care. METHODS Consenting type 2 diabetes patients attending diabetes outpatient clinic appointments at three hospitals in the Tamale Metropolis of Ghana completed a cross-sectional survey comprising the Summary of Diabetes Self-Care Activities Measure, and questions about demographic characteristics and diabetes history. Height and weight were also measured. Multiple linear regression analyses were conducted to identify the factors associated with adherence to each of the four self-care behaviours. RESULTS In the last 7 days, participants exercised for a mean (SD) of 4.78 (2.09) days and followed diet, foot care and SMBG for a mean (SD) of 4.40 (1.52), 2.86 (2.16) and 2.15 (0.65) days, respectively. More education was associated with a higher frequency of reported participation in exercise (r = 0.168, p = 0.022), following a healthy diet (r = 0.223, p = 0.002) and foot care (r = 0.153, p = 0.037) in the last 7 days. Males reported performing SMBG (r = 0.198, p = 0.007) more frequently than their female counterparts. CONCLUSION Adherence to diet, SMBG and checking of feet were relatively low. People with low education and women may need additional support to improve adherence to self-care behaviours in this type 2 diabetes population.
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Affiliation(s)
- Victor Mogre
- Department of Health Professions Education, School of Medicine and Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana.
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Zakaria Osman Abanga
- Department of Community Nutrition, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, NSW, 2305, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, NSW, 2287, Australia
| | - Natalie A Johnson
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, NSW, 2305, Australia
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Rintala TM, Paavilainen E, Åstedt-Kurki P. Everyday life of a family with diabetes as described by adults with type 1 diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hortensius J, Vrijhoef HJ, Groenier KH, Pool A, Kleefstra N, Bijl JJVD. Development and Validation of the Perception of Self-Monitoring of Blood Glucose Scale in Insulin-Treated Patients With Diabetes. J Nurs Meas 2015; 23:57-71. [DOI: 10.1891/1061-3749.23.1.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: The Perception of Self-Monitoring of Blood Glucose (P-SMBG) scale was developed and validated to assess perceptions of self-monitoring of blood glucose (SMBG) in insulin-treated patients with diabetes. Method: An initial 68-item version of the P-SMBG has been evaluated by a panel of professionals and patients. A sample of 375 patients tested the revised scale. Results: Factor analysis suggested a 19-item scale and a 2-factor structure, separating negatively and positively worded items. Cronbach’s alpha was .84 and .72, and the intraclass correlation coefficient was .66 and .57, respectively for both factors. Item–total correlations were in the range of .23–.66. Convergent/divergent validity was confirmed for the negatively worded items. Conclusions: The final P-SMBG scale (21 items) can be used to assess positive and negative perceptions of SMBG in insulin-treated patients with diabetes.
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Walker TC, Yucha CB. Continuous glucose monitors: use of waveform versus glycemic values in the improvements of glucose control, quality of life, and fear of hypoglycemia. J Diabetes Sci Technol 2014; 8:488-93. [PMID: 24876611 PMCID: PMC4455439 DOI: 10.1177/1932296814528434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
How patients are benefitting from continuous glucose monitoring (CGM) remains poorly understood. The focus on numerical glucose values persists, even though access to the glucose waveform and rate of change may contribute more to improved control. This pilot study compared outcomes of patients using CGMs with or without access to the numerical values on their CGM. Ten persons with type 1 diabetes, naïve to CGM use, enrolled in a 12-week study. Subjects were randomly assigned to either unmodified CGM receivers, or to CGM receivers that had their numerical values obscured but otherwise functioned normally. HbA1c, quality of life (QLI-D), and fear of hypoglycemia (HFS) were assessed, at baseline and at week 12. Baseline HbA1c for the entire group was 7.46 ± 1.27%. At week 12 the experimental group HbA1c reduction was 1.5 ± 0.9% (p < .05), the control group's reduction was 0.06 ± 0.61% (p > .05). Repeated measures testing revealed no significant difference in HbA1c reduction between groups. Both groups had reductions in HFS; these reductions were statistically significant within groups (p < .05), but not between groups. QLI-D indices demonstrated improvements (p < .05) in QLI-D total and the health and family subscales, but not between groups. The results of this pilot study suggest that benefits of CGM extend beyond reductions in HbA1c to reductions in fear of hypoglycemia and improvements in quality of life. The display of a numerical glucose value did not improve control when compared to numerically blinded units.
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Hortensius J, Kars MC, Wierenga WS, Kleefstra N, Bilo HJ, van der Bijl JJ. Perspectives of patients with type 1 or insulin-treated type 2 diabetes on self-monitoring of blood glucose: a qualitative study. BMC Public Health 2012; 12:167. [PMID: 22397638 PMCID: PMC3311150 DOI: 10.1186/1471-2458-12-167] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 03/08/2012] [Indexed: 11/25/2022] Open
Abstract
Background Self-monitoring of blood glucose (SMBG), including self-regulation, is an important tool to achieve good glycemic control. However, many patients measure their glucose concentrations less often than is recommended. This study investigates patients' perspectives of SMBG and all relevant aspects influencing SMBG in patients with type 1 and insulin-treated type 2 diabetes. Methods In depth interviews were conducted with 13 patients with type 1 diabetes from an outpatient clinic and 15 patients with type 2 diabetes from general practices. All interviews were transcribed verbatim and analyzed using the Grounded Theory approach. Results A wide variety of SMBG was encountered. Perceptions, goals of SMBG and personal and contextual factors were identified, influencing the respondents' perspective of SMBG, and leading to this variety. Respondents experienced a discrepancy between their own and the professionals' perceptions and goals. Respondents' perception of SMBG ranged along a continuum from 'friend' to 'foe'. With respect to the goals, the respondents experienced tension between achieving good glycemic control and quality of life, and deliberately made their own choices. The performance of SMBG was tailored to their perceptions and personal goals. Personal and contextual factors such as hypo- or hyper (un)awareness, knowledge, and contact with professionals acted as either facilitating factors or as barriers to SMBG, depending on the respondents' perspective. A SMBG model was developed providing a representation of the factors and their interrelations. Respondents with type 1 diabetes seemed more resigned to their situation and SMBG was more integrated into their lives. Conclusions From the patients' perspective, professionals positively present SMBG as a 'friend' in order to achieve strict glycemic control. Whereas patients can also perceive SMBG as a 'foe'. They primarily seek a personal balance between achieving glycemic control and quality of life, leading them to deliberately make other choices regarding SMBG performance than was recommended. Gaining insight and discussing all factors affecting SMBG will help professionals and patients come to mutually agreed goals and to tailor the performance of SMBG to the individual patient. This should result in a more optimal use of SMBG, an improved quality of life, and improved clinical parameters.
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