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Li Y, Zhong Q, Zhu S, Cheng H, Huang W, Wang HHX, Li YT. Frequency of Follow-Up Attendance and Blood Glucose Monitoring in Type 2 Diabetic Patients at Moderate to High Cardiovascular Risk: A Cross-Sectional Study in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114175. [PMID: 36361055 PMCID: PMC9656430 DOI: 10.3390/ijerph192114175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 05/17/2023]
Abstract
Regular follow-up attendance in primary care and routine blood glucose monitoring are essential in diabetes management, particularly for patients at higher cardiovascular (CV) risk. We sought to examine the regularity of follow-up attendance and blood glucose monitoring in a primary care sample of type 2 diabetic patients at moderate-to-high CV risk, and to explore factors associated with poor engagement. Cross-sectional data were collected from 2130 patients enrolled in a diabetic retinopathy screening programme in Guangdong province, China. Approximately one-third of patients (35.9%) attended clinical follow-up <4 times in the past year. Over half of patients (56.9%) failed to have blood glucose monitored at least once per month. Multivariable logistic regression analysis showed that rural residents (adjusted odds ratio [aOR] = 0.420, 95% confidence interval [CI] = 0.338-0.522, p < 0.001, for follow-up attendance; aOR = 0.580, 95%CI: 0.472-0.712, p < 0.001, for blood glucose monitoring) and subjects with poor awareness of adverse consequences of diabetes complications (aOR = 0.648, 95%CI = 0.527-0.796, p < 0.001, for follow-up attendance; aOR = 0.770, 95%CI = 0.633-0.937, p = 0.009, for blood glucose monitoring) were both less likely to achieve active engagement. Our results revealed an urban-rural divide in patients' engagement in follow-up attendance and blood glucose monitoring, which suggested the need for different educational approaches tailored to the local context to enhance diabetes care.
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Affiliation(s)
- Yunyi Li
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Qiya Zhong
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Sufen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Hui Cheng
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Harry H. X. Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
- Correspondence: (H.H.X.W.); (Y.-T.L.)
| | - Yu-Ting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
- Correspondence: (H.H.X.W.); (Y.-T.L.)
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Pfoh ER, Linfield D, Speaker SL, Roufael JS, Yan C, Misra-Hebert AD, Rothberg MB. Patient Perspectives on Self-Monitoring of Blood Glucose When not Using Insulin: a Cross-sectional Survey. J Gen Intern Med 2022; 37:1673-1679. [PMID: 34389935 PMCID: PMC9130377 DOI: 10.1007/s11606-021-07047-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/14/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Professional societies have recommended against use of self-monitoring blood glucose (SMBG) in non-insulin-treated type 2 diabetes (NITT2D) to control blood sugar levels, but patients are still monitoring. OBJECTIVE To understand patients' motivation to monitor their blood sugar, and whether they would stop if their physician suggested it. DESIGN Cross-sectional in-person and electronic survey conducted between 2018 and 2020. PARTICIPANTS Adults with type 2 diabetes not using insulin who self-monitor their blood sugar. MAIN MEASURES The survey included questions about frequency and reason for using SMBG, and the impact of SMBG on quality of life and worry. It also asked, "If your doctor said you could stop checking your blood sugar, would you?" We categorized patients based on whether they would stop. To identify the characteristics independently associated with desire to stop SMBG, we performed a logistic regression using backward stepwise selection. KEY RESULTS We received 458 responses. The common reasons for using SMBG included the doctor wanted the patient to check (67%), desire to see the number (65%), and desire to see if their medications were working (61%). Forty-eight percent of respondents stated that using SMBG reduced their worry about their diabetes and 61% said it increased their quality of life. Fifty percent would stop using SMBG if given permission. In the regression model, respondents who said that they check their blood sugar levels because "I was told to" were more likely to want to stop (AOR: 1.69, 95%CI: 1.11, 2.58). Those that used SMBG due to habit and to understand their diabetes better had lower odds of wanting to stop (AOR: 0.33, 95%CI: 0.18-0.62; AOR: 0.60, 95%CI: 0.39-0.93, respectively). CONCLUSIONS Primary care physicians should discuss patients' reasons for using SMBG and offer them the option of discontinuing.
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Affiliation(s)
- Elizabeth R Pfoh
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA.
| | - Debra Linfield
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Sidra L Speaker
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Joud S Roufael
- College of Public Health, Kent State University, Kent, OH, USA
| | - Chen Yan
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA
| | - Anita D Misra-Hebert
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA
- Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA
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Perceptions by Adult Patients With Type 1 and 2 Diabetes of Current and Advanced Technologies of Blood Glucose Monitoring: A Prospective Study. Can J Diabetes 2019; 43:27-33. [DOI: 10.1016/j.jcjd.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/08/2018] [Indexed: 11/20/2022]
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RSSDI consensus on self-monitoring of blood glucose in types 1 and 2 diabetes mellitus in India. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0677-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Chen CM, Hung LC, Chen YL, Yeh MC. Perspectives of patients with non-insulin-treated type 2 diabetes on self-monitoring of blood glucose: A qualitative study. J Clin Nurs 2018; 27:1673-1683. [PMID: 29266453 DOI: 10.1111/jocn.14227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES To explore experiences of self-monitoring of blood glucose among patients with non-insulin-treated type 2 diabetes. BACKGROUND Self-monitoring of blood glucose is essential to diabetes care and facilitates glycaemic control. Patients' perspectives of self-monitoring of blood glucose have seldom been discussed in the literature, and engagement in self-monitoring of blood glucose is consistently low. DESIGN The descriptive phenomenological method was used. METHODS Purposive sampling was conducted to recruit participants from the endocrinology departments of medical institutions in Taiwan based on the following criteria: (i) having a medical diagnosis of type 2 diabetes, (ii) not being treated with insulin, (iii) having engaged in self-monitoring of blood glucose at least once within the preceding 6 months, (iv) being at least 20 years old and (v) not having any major mental or cognitive disorders. Data were collected in outpatient consultation rooms, the participants' homes and other settings where the participants felt secure and comfortable. In-depth interviews were conducted to collect data from 16 patients with diabetes. RESULTS The participants perceived that lifestyle affected blood glucose levels and did not know how to handle high or low blood glucose levels. Their willingness to continue self-monitoring of blood glucose depended on whether healthcare professionals checked or discussed their blood glucose levels with them. CONCLUSIONS The patients' knowledge regarding blood glucose variation and healthcare professionals' attitudes affected the patients' self-monitoring of blood glucose behaviours. The empirical findings illustrated self-monitoring of blood glucose experiences and recommended that healthcare professionals' closely attend to patients' requirements and responses to diabetes and incorporate the self-monitoring of blood glucose into therapy plans. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should reinforce patients' knowledge on appropriate responses to high and low blood glucose levels, intervene appropriately, discuss self-monitoring of blood glucose results with patients and track these results.
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Affiliation(s)
- Chen-Mei Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Li-Chen Hung
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | | | - Mei Chang Yeh
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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van Lint C, Wang W, van Dijk S, Brinkman WP, Rövekamp TJ, Neerincx MA, Rabelink TJ, van der Boog PJ. Self-Monitoring Kidney Function Post Transplantation: Reliability of Patient-Reported Data. J Med Internet Res 2017; 19:e316. [PMID: 28951385 PMCID: PMC5640424 DOI: 10.2196/jmir.7542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 11/24/2022] Open
Abstract
Background The high frequency of outpatient visits after kidney transplantation is burdensome to both the recovering patient and health care capacity. Self-monitoring kidney function offers a promising strategy to reduce the number of these outpatient visits. Objective The objective of this study was to investigate whether it is safe to rely on patients’ self-measurements of creatinine and blood pressure, using data from a self-management randomized controlled trial. Methods For self-monitoring creatinine, each participant received a StatSensor Xpress-i Creatinine Meter and related test material. For self-monitoring blood pressure, each participant received a Microlife WatchBP Home, an oscillometric device for blood pressure self-measurement on the upper arm. Both devices had a memory function and the option to download stored values to a computer. During the first year post transplantation, 54 patients registered their self-measured creatinine values in a Web-based Self-Management Support System (SMSS) which provided automatic feedback on the registered values (eg, seek contact with hospital). Values registered in the SMSS were compared with those logged automatically in the creatinine device to study reliability of registered data. Adherence to measurement frequency was determined by comparing the number of requested with the number of performed measurements. To study adherence to provided feedback, SMSS-logged feedback and information from the electronic hospital files were analyzed. Results Level of adherence was highest during months 2-4 post transplantation with over 90% (42/47) of patients performing at least 75% of the requested measurements. Overall, 87.00% (3448/3963) of all registered creatinine values were entered correctly, although values were often registered several days later. If (the number of) measured and registered values deviated, the mean of registered creatinine values was significantly lower than what was measured, suggesting active selection of lower creatinine values. Adherence to SMSS feedback ranged from 53% (14/24) to 85% (33/39), depending on the specific feedback. Conclusions Patients’ tendency to postpone registration and to select lower creatinine values for registration and the suboptimal adherence to the feedback provided by the SMSS might challenge safety. This should be well considered when designing self-monitoring care systems, for example by ensuring that self-measured data are transferred automatically to an SMSS.
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Affiliation(s)
- Céline van Lint
- Leiden University Medical Center, Department of Nephrology, Leiden, Netherlands
| | - Wenxin Wang
- Interactive Intelligence Group, Delft University of Technology, Delft, Netherlands
| | - Sandra van Dijk
- Department of Health, Medical and Neuropsychology and Behavioural Sciences, Leiden University, Leiden, Netherlands
| | - Willem-Paul Brinkman
- Interactive Intelligence Group, Delft University of Technology, Delft, Netherlands
| | - Ton Jm Rövekamp
- Dutch Organization for Applied Scientific Research (TNO), the Hague, Netherlands
| | - Mark A Neerincx
- Interactive Intelligence Group, Delft University of Technology, Delft, Netherlands.,Dutch Organization for Applied Scientific Research (TNO), the Hague, Netherlands
| | - Ton J Rabelink
- Leiden University Medical Center, Department of Nephrology, Leiden, Netherlands
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Al-Keilani MS, Almomani BA, Al-Sawalha NA, Shhabat BA. Self-monitoring of blood glucose among patients with diabetes in Jordan: Perception, adherence, and influential factors. Diabetes Res Clin Pract 2017; 126:79-85. [PMID: 28236721 DOI: 10.1016/j.diabres.2017.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 09/25/2016] [Accepted: 01/10/2017] [Indexed: 12/24/2022]
Abstract
AIMS To investigate the self-monitoring of blood glucose (SMBG) adherence among Jordanian patients with diabetes and to identify the predictive factors. METHODS A cross-sectional survey was carried out in 18 hospitals and healthcare centers covering south, north, and middle of Jordan. All patients with diabetes attending endocrinology clinics from May to December, 2015 were approached. The questionnaires were distributed by trained pharmacists and were self-administered. RESULTS A total of 1079 participants completed the survey. Only 59% of participants were SMBG adherent. Predictors of SMBG adherence were treatment regimen; insulin with oral hypoglycemic agents (p=0.044, CI 1.023-5.274, OR=2.323) or insulin only (p=0.005, CI 1.225-3.115, OR=1.953), and health education on how to use the SMBG meter (p<0.001, CI 10.538-32.497, OR=18.506). The frequency of SMBG was significantly associated with the treatment regimen, with patients who were taking oral hypoglycemic agents (p<0.001) or insulin therapy (p=0.004) tested more frequently as compared to others. Additionally, the frequency of testing was significantly associated with the reason of performing SMBG (p<0.001). Frequency of daily testing was the highest among patients who performed SMBG to know if they were hypoglycemic (48.9%) or hyperglycemic (48.0%), or to inform their doctors (28.4%). CONCLUSIONS SMBG adherence was suboptimal. Predictors of SMBG adherence were treatment regimen and health education about the SMBG meter.
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Affiliation(s)
- Maha S Al-Keilani
- Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
| | - Basima A Almomani
- Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
| | - Nour A Al-Sawalha
- Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
| | - Batool A Shhabat
- King Abdulla University Hospital, P.O. Box 3030, Irbid 22110, Jordan.
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8
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Reduction in self-monitoring of blood glucose in type 2 diabetes: an observational controlled study in east London. Br J Gen Pract 2016; 65:e256-63. [PMID: 25824186 DOI: 10.3399/bjgp15x684421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) confers no benefit for many people with type 2 diabetes not being treated with insulin. It accounts for 21% of diabetes prescribing costs. AIM To improve care quality at reduced cost for type 2 diabetes by reducing unnecessary SMBG. DESIGN AND SETTING Non-randomised, observational controlled study in two intervention clinical commissioning groups (CCGs) and one control CCG in east London. METHOD In total, 19,602 people with type 2 diabetes not being treated with insulin were recruited from two intervention CCGs; 16,033 were recruited from a control CCG. The intervention (from 2010 to 2013) comprised implementation of a locally developed guideline, including IT support and peer feedback of performance. Data on practice prescribing SMBG testing strips were gathered using GP electronic health records. Information on costs were obtained via the ePACT electronic database. RESULTS Over 4 years, in all non-insulin type 2 diabetes treatment groups, use of SMBG was reduced in the two intervention CCGs from 42.8% to 16.5%, and in the control CCG from 56.4% to 47.2%. In people on metformin alone or no treatment, intervention CCGs reduced SMBG use from 29.6% to 6.0%, and in the control CCG use dropped from 47.1% to 38.7% (P<0.001). From 2009 to 2012 the total cost of all SMBG prescribing (type 1 and type 2 diabetes, including users of insulin) was reduced by 4.9% (£62,476) in the two intervention CCGs and increased in the control CCG by 5.0% (£42,607); in England, the total cost increased by 13.5% (£19.4 million). In total, 20% (3865 of 19 602) fewer patients used SMBG in the intervention CCGs. CONCLUSION This low-cost programme demonstrated a major reduction in unnecessary prescribing of SMBG, along with cost savings. If replicated nationally, this would avoid unnecessary testing in 340 000 people and prescribing costs that total £21.8 million.
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van Lint CL, van der Boog PJM, Romijn FPHTM, Schenk PW, van Dijk S, Rövekamp TJM, Kessler A, Siekmann L, Rabelink TJ, Cobbaert CM. Application of a point of care creatinine device for trend monitoring in kidney transplant patients: fit for purpose? Clin Chem Lab Med 2016; 53:1547-56. [PMID: 25719331 DOI: 10.1515/cclm-2014-0932] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 01/18/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND The StatSensor® Xpress-i™, a point-of-care system for blood creatinine measurement, offers patients the possibility of self-monitoring creatinine. In this study, the analytical performance of the StatSensor® for both detecting current renal function and monitoring renal (dys)function in kidney transplant patients was examined. METHODS Accuracy of the StatSensor® with capillary and venous whole blood was evaluated and compared to an isotopic dilution mass spectrometry (IDMS)-traceable enzymatic creatinine test in venous serum (n=138). Twenty Li-heparin samples were compared to the IDMS reference method performed by a Joint Committee for Traceability in Laboratory Medicine (JCTLM)-listed reference laboratory (RfB, Bonn, Germany). To evaluate StatSensor®'s suitability to monitor kidney function, both venous and capillary samples were obtained in 20 hospitalized transplantation patients. Venous samples were analyzed with an IDMS-traceable enzymatic test, capillary samples were measured using the StatSensor®. For all 2-day intervals, percentage change in creatinine was compared between both methods. RESULTS The StatSensor® did not meet total allowable error criterion of 6.9%. Average overall CVa for the StatSensor® was 10.4% and 5.2% for capillary and venous whole blood results, respectively. Overall CVa for the central laboratory serum creatinine method was <1.5%. For monitoring renal (dys)function, total agreement of the StatSensor® with an IDMS-traceable enzymatic test was 68% using a 10% Δ change. No significant differences were found between the changes observed by both methods. CONCLUSIONS Capillary blood testing with the StatSensor® is not advisable for determining current renal function with a single creatinine measurement in kidney transplant patients, mainly due to excessive analytical imprecision. However, our results suggest that capillary blood testing with the StatSensor® can be used for daily trend monitoring of kidney function after renal transplantation.
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Malanda UL, Bot SDM, Kostense PJ, Snoek FJ, Dekker JM, Nijpels G. Effects of self-monitoring of glucose on distress and self-efficacy in people with non-insulin-treated Type 2 diabetes: a randomized controlled trial. Diabet Med 2016; 33:537-46. [PMID: 26171942 DOI: 10.1111/dme.12849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 11/27/2022]
Abstract
AIMS To investigate the effects of self-monitoring of glucose in blood or urine, on diabetes-specific distress and self-efficacy, compared with usual care in people with non-insulin-treated Type 2 diabetes mellitus. METHODS One hundred and eighty-one participants with non-insulin-treated Type 2 diabetes mellitus [diabetes duration ≥ 1 year, age 45-75 years, HbA1c ≥ 53.0 mmol/mol (7.0%), self-monitoring frequency < 3 times in the previous year] were randomly assigned to blood self-monitoring (n = 60), urine self-monitoring (n = 59) or usual care (n = 62). Primary outcomes were between-group differences in diabetes-specific distress [Problem Areas in Diabetes scale (PAID)] and self-efficacy [Confidence in Diabetes Self-Care questionnaire (CIDS-2)] after 12 months. Secondary outcomes included changes in HbA1c , treatment satisfaction and depressive symptoms. RESULTS There were no statistically significant between-group differences in changes in PAID and CIDS-2 after 12 months. Mean difference in PAID between blood monitoring and control was -2.2 [95% confidence interval (CI) -7.1 to 2.7], between urine monitoring and control was -0.9 (95% CI -4.4 to 2.5) and between blood monitoring and urine monitoring was -2.0 (95% CI -4.1 to 0.1). Mean difference in CIDS-2 between blood monitoring and control was 0.6 [95% CI (-2.0 to 2.1), between urine monitoring and control was 2.8 (95% CI -2.3 to 7.9)] and between blood monitoring and urine monitoring was -3.3 (95% CI -7.9 to 1.3). No statistically significant between-group differences in change in any of the secondary outcome measures were found. CONCLUSIONS This study did not find statistical or clinical evidence for a long-term effect of self-monitoring of glucose in blood or urine on diabetes-specific distress and self-efficacy in people with moderately controlled non-insulin-treated Type 2 diabetes mellitus. (Current Controlled Trials ISRCTN84568563).
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Affiliation(s)
- U L Malanda
- Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - S D M Bot
- Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - P J Kostense
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - F J Snoek
- Department of Medical Psychology, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - J M Dekker
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - G Nijpels
- Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands
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Ziegler R, Eichholz R, Schulz B. Use of a Combined Blood-Glucose- and ß-Ketone-Measuring Device Improves Glycemic Control in Insulin-Treated Patients With Diabetes: The Gold Plus Study. J Diabetes Sci Technol 2015; 9:1270-4. [PMID: 25986628 PMCID: PMC4667309 DOI: 10.1177/1932296815587936] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Using self-measurements of blood glucose (SMBG) is daily routine for patients with insulin-treated diabetes, however measuring ß-ketones in blood is not widespread. How the use of a combined device, which can measure both, is accepted in daily routine by patients and will lead to better glycemic control is not well studied. METHODS This multicenter, prospective, noninterventional study assessed the impact of routine use of the GlucoMen® LX Plus on patient acceptance, usage and glycemic control among insulin-treated patients with diabetes mellitus type 1 and type 2. A1c and self-reported frequency of SMBG were evaluated at baseline and also postprandial SMBG, ß-ketone measurements, and use of reminders after 3 and 6 months of use. A total of 631 patients, 254 type 1/350 type 2 (27 no type specified), with mean (SD) baseline A1c 8.5% (1.5), age 54.6 (15.6) years, and 47.3% female were studied. RESULTS Frequent use of SMBG at baseline led to a higher decrease in A1c at 6 month (V3): -0.3% if SMBG measured up to 1/day versus -0.9% in 4-6/day. Increase of SMBG frequency during the study showed also a negative correlation to A1c, 9.2% at V1 versus 7.6% at V3. Postprandial SMBG was done by 77.7% and ß-ketone measurements by 45.5% of all patients; the reminders were used by 33.4% and led to an increased frequency of SMBG at 6 months. CONCLUSIONS A combined device for SMBG and ß-ketone measurements is well accepted by patients with insulin-treated diabetes and can lead through the avoidance or detection of ketoacidosis/increased frequency of SMBG and increased awareness of the patients to an improved glycemic outcome.
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Affiliation(s)
- Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Muenster, Germany
| | | | - Birgit Schulz
- A. Menarini Diagnostics, Division of Berlin-Chemie AG, Berlin, Germany
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12
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van Lint CL, van der Boog PJM, Wang W, Brinkman WP, Rövekamp TJM, Neerincx MA, Rabelink TJ, van Dijk S. Patient experiences with self-monitoring renal function after renal transplantation: results from a single-center prospective pilot study. Patient Prefer Adherence 2015; 9:1721-31. [PMID: 26673985 PMCID: PMC4676625 DOI: 10.2147/ppa.s92108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND After a kidney transplantation, patients have to visit the hospital often to monitor for early signs of graft rejection. Self-monitoring of creatinine in addition to blood pressure at home could alleviate the burden of frequent outpatient visits, but only if patients are willing to self-monitor and if they adhere to the self-monitoring measurement regimen. A prospective pilot study was conducted to assess patients' experiences and satisfaction. MATERIALS AND METHODS For 3 months after transplantation, 30 patients registered self-measured creatinine and blood pressure values in an online record to which their physician had access to. Patients completed a questionnaire at baseline and follow-up to assess satisfaction, attitude, self-efficacy regarding self-monitoring, worries, and physician support. Adherence was studied by comparing the number of registered with the number of requested measurements. RESULTS Patients were highly motivated to self-monitor kidney function, and reported high levels of general satisfaction. Level of satisfaction was positively related to perceived support from physicians (P<0.01), level of self-efficacy (P<0.01), and amount of trust in the accuracy of the creatinine meter (P<0.01). The use of both the creatinine and blood pressure meter was considered pleasant and useful, despite the level of trust in the accuracy of the creatinine device being relatively low. Trust in the accuracy of the creatinine device appeared to be related to level of variation in subsequent measurement results, with more variation being related to lower levels of trust. Protocol adherence was generally very high, although the range of adherence levels was large and increased over time. CONCLUSION Patients' high levels of satisfaction suggest that at-home monitoring of creatinine and blood pressure after transplantation offers a promising strategy. Important prerequisites for safe implementation in transplant care seem to be support from physicians and patients' confidence in both their own self-monitoring skills and the accuracy of the devices used.
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Affiliation(s)
- Céline L van Lint
- Department of Nephrology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
- Correspondence: Céline L van Lint, Department of Nephrology, Leiden University Medical Centre (LUMC), PO Box 9600, Leiden 2300 RC, the Netherlands, Tel +31 71 526 2214, Email
| | - Paul JM van der Boog
- Department of Nephrology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Wenxin Wang
- Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, the Netherlands
- Department of Technology in Healthcare, Prevention and Health, Dutch Organization for Applied Scientific Research (TNO), Leiden, the Netherlands
| | - Willem-Paul Brinkman
- Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - Ton JM Rövekamp
- Department of Technology in Healthcare, Prevention and Health, Dutch Organization for Applied Scientific Research (TNO), Leiden, the Netherlands
| | - Mark A Neerincx
- Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - Ton J Rabelink
- Department of Nephrology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Sandra van Dijk
- Department of Nephrology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
- Department of Health, Medical and Neuropsychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
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13
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Chen CM, Chang Yeh M. The experiences of diabetics on self-monitoring of blood glucose: a qualitative metasynthesis. J Clin Nurs 2014; 24:614-26. [DOI: 10.1111/jocn.12691] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Chen-Mei Chen
- Department of Nursing; Chang Gung University of Science and Technology; Taipei Taiwan
- Department of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
| | - Mei Chang Yeh
- Department of Nursing; College of Medicine; National Taiwan University; Taipei Taiwan
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14
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Lee WC, Smith E, Chubb B, Wolden ML. Frequency of blood glucose testing among insulin-treated diabetes mellitus patients in the United Kingdom. J Med Econ 2014; 17:167-75. [PMID: 24359593 DOI: 10.3111/13696998.2013.873722] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Through a retrospective database analysis, this study seeks to provide an understanding of the utilization of SMBG by insulin therapy and diabetes type and to estimate healthcare costs of blood glucose monitoring in the UK diabetes population. METHODS Data were obtained from the IMS LifeLink Electronic Medical Record-Europe (EMR-EU) Database, a longitudinal database containing anonymized patient records from physician-practice data systems of office-based physicians in the UK. Depending on the insulin types used for type 1 and type 2 diabetes, patients were sub-categorized into one of four insulin regimen groups (basal, bolus, pre-mixed, or basal-bolus). Frequency of blood glucose testing was assessed descriptively throughout the 12-month post-index period, and generalized linear models were used to evaluate the effect of baseline characteristics, including insulin type, on the likelihood of blood glucose test utilization. Healthcare resource utilization and costs for all-cause services were assessed by insulin type. RESULTS This study identified 8322 type 1 and type 2 diabetes patients with two insulin pharmacy records between January 1, 2009 and December 31, 2010. After applying study inclusion and exclusion criteria, a total of 2676 (32.2%) insulin-treated diabetes mellitus patients in the UK were identified, with the number of pharmacy blood glucose test strips averaging 771.1 (median 600). The glucose testing frequency was lowest among basal-only insulin patients and pre-mixed insulin patients (mean=576.2 [median=450] and mean=599.5 [median=500], respectively; non-significantly different) compared to other insulin types. CONCLUSION Although the data did not capture the glucose frequency comprehensively, it varied significantly by insulin types, and was higher than what is recommended in the guidelines for patients with type 2 diabetes.
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Affiliation(s)
- Won Chan Lee
- IMS Health , 1725 Duke St, Suite 510, Alexandria, VA , USA
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15
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Klonoff DC, Blonde L, Cembrowski G, Chacra AR, Charpentier G, Colagiuri S, Dailey G, Gabbay RA, Heinemann L, Kerr D, Nicolucci A, Polonsky W, Schnell O, Vigersky R, Yale JF. Consensus report: the current role of self-monitoring of blood glucose in non-insulin-treated type 2 diabetes. J Diabetes Sci Technol 2011; 5:1529-48. [PMID: 22226276 PMCID: PMC3262725 DOI: 10.1177/193229681100500630] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Coalition for Clinical Research--Self-Monitoring of Blood Glucose Scientific Board convened a meeting in San Francisco, CA, July 20-21, 2011, to discuss the current practice of self-monitoring of blood glucose (SMBG) in non-insulin-treated (NIT) type 2 diabetes mellitus (T2DM). Twelve physician panel members from academia, practice, and government attended this meeting. These experts came from the United States, Brazil, Canada, France, Germany, Italy, and the United Kingdom. In addition, three consultants from Australia, Germany, and the United States contributed to the group's final report. This coalition was organized by Diabetes Technology Society. Self-monitoring of blood glucose was studied from eight perspectives related to patients with NIT T2DM: (1) epidemiological studies; (2) randomized controlled trials (RCT)s and meta-analyses; (3) targets, timing, and frequency of SMBG use; (4) incidence and role of SMBG in preventing hypoglycemia with single-drug regimens and combination regimens consisting of antihyperglycemic agents other than secretagogues and insulin; (5) comparison of SMBG with continuous glucose monitoring; (6) technological capabilities and limitations of SMBG; (7) barriers to appropriate use of SMBG; and (8) methods and end points for appropriate future clinical trials. The panel emphasized recent studies, which reflect the current approach for applying this intervention. Among the participants there was consensus that: SMBG is an established practice for patients with NIT T2DM, and to be most effective, it should be performed in a structured format where information obtained from this measurement is used to guide treatment; New, high-quality efficacy data from RCTs have demonstrated efficacy of SMBG in NIT T2DM in trials reported since 2008; Both patients and health care professionals require education on how to respond to the data for SMBG to be effective; and Additional well-defined studies are needed to assess the benefits and costs of SMBG with end points not limited to hemoglobin A1c.
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Affiliation(s)
- David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, California 94401, USA.
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