Implications of remote monitoring Technology in Optimizing Traditional Self-Monitoring of blood glucose in adults with T2DM in primary care

Abstract Background Self-monitoring of blood glucose (SMBG) has been shown to reduce hemoglobin A1C (HbA1C). Accordingly, guidelines recommend SMBG up to 4–10 times daily for adults with type 2 diabetes (T2DM) on insulin. For persons not on insulin, recommendations are equivocal. Newer technology-enabled blood glucose monitoring (BGM) devices can facilitate remote monitoring of glycemic data. New evidence generated by remote BGM may help to guide best practices for frequency and timing of finger-stick blood glucose (FSBG) monitoring in uncontrolled T2DM patients managed in primary care settings. This study aims to evaluate the impact of SMBG utility and frequency on glycemic outcomes using a novel BGM system which auto-transfers near real-time FSBG data to a cloud-based dashboard using cellular networks. Methods Secondary analysis of the intervention arm of a comparative non-randomized trial with propensity-matched chart controls. Adults with T2DM and HbA1C > 9% receiving care in five primary care practices in a healthcare system participated in a 3-month diabetes boot camp (DBC) using telemedicine and a novel BGM to support comprehensive diabetes care management. The primary independent variable was frequency of FSBG. Secondary outcomes included frequency of FSBG by insulin status, distribution of FSBG checks by time of day, and hypoglycemia rates. Results 48,111 FSBGs were transmitted by 359 DBC completers. Participants performed 1.5 FSBG checks/day; with 1.6 checks/day for those on basal/bolus insulin. Higher FSBG frequency was associated with greater improvement in HbA1C independent of insulin treatment status (p = 0.0003). FSBG frequency was higher in patients treated with insulin (p = 0.003). FSBG checks were most common pre-breakfast and post-dinner. Hypoglycemia was rare (1.2% < 70 mg/dL). Conclusions Adults with uncontrolled T2DM achieved significant HbA1C improvement performing just 1.5 FSBGs daily during a technology-enabled diabetes care intervention. Among the 40% taking insulin, this improvement was achieved with a lower FSBG frequency than guidelines recommend. For those not on insulin, despite a lower frequency of FSBG, they achieved a greater reduction in A1C compared to patients on insulin. Low frequency FSBG monitoring pre-breakfast and post-dinner can potentially support optimization of glycemic control regardless of insulin status in the primary care setting. Trial registration Trial registration number:NCT02925312 (10/19/2016).

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Implications of Remote Monitoring Technology in Optimizing Traditional Self-Monitoring of Blood Glucose in Adults with T2DM in primary care

10.21203/rs.3.rs-672031/v1 ◽

2021 ◽

Author(s):

Alex R. Montero ◽

David Toro Tobon ◽

Kelly Gann ◽

Carine M. Nassar ◽

Gretchen A. Youssef ◽

...

Keyword(s):

Primary Care ◽

Blood Glucose ◽

Remote Monitoring ◽

Secondary Analysis ◽

Glucose Monitoring ◽

Time Of Day ◽

Blood Glucose Monitoring ◽

Self Monitoring ◽

Finger Stick ◽

The Impact

Abstract Background: Self-monitoring of blood glucose (SMBG) has been shown to reduce hemoglobin A1C (HbA1C). Accordingly, guidelines recommend SMBG up to 4-10 times daily for adults with type 2 diabetes (T2DM) on insulin. For persons not on insulin, recommendations are equivocal. Newer technology-enabled blood glucose monitoring (BGM) devices can facilitate remote monitoring of glycemic data. New evidence generated by remote BGM may help to guide best practices for frequency and timing of finger-stick blood glucose (FSBG) monitoring in uncontrolled T2DM patients managed in primary care settings. Objective: To evaluate the impact of SMBG utility and frequency on glycemic outcomes using a novel BGM system which auto-transfers near real-time FSBG data to a cloud-based dashboard using cellular networks.Design: Secondary analysis of the intervention arm of a comparative non-randomized trial with propensity-matched chart controls.Participants: Adults with T2DM and HbA1C >9% receiving care in five primary care practices in a healthcare system. Interventions: Participation in a 3-month diabetes boot camp (DBC) using telemedicine and a novel BGM to support comprehensive diabetes care management. Main Measures: The primary independent variable was frequency of FSBG. Secondary outcomes included frequency of FSBG by insulin status, distribution of FSBG checks by time of day, and hypoglycemia rates.

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The Impact of Structured Self-Monitoring of Blood Glucose Combined With Intensive Education on HbA1c Levels, Hospitalizations, and Quality-of-Life Parameters in Insulin-Treated Patients With Diabetes at Primary Care in Serbia: The Multicenter SPA-EDU Study

Journal of Diabetes Science and Technology ◽

10.1177/1932296816681323 ◽

2016 ◽

Vol 11 (4) ◽

pp. 746-752 ◽

Cited By ~ 4

Author(s):

Nebojša M. Lalić ◽

Katarina Lalić ◽

Aleksandra Jotić ◽

Dejan Stanojević ◽

Dragana Živojinović ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Primary Care ◽

Blood Glucose ◽

Self Monitoring ◽

Intensive Education ◽

Distress Scale ◽

The Impact ◽

Hba1c Levels

Background: We assessed the effect of structured self-monitoring of blood glucose (SMBG), in combination with intensive education, on metabolic control, SMBG frequency, hospitalizations, cardiovascular risk factors, and quality-of-life parameters in patients with insulin-treated diabetes in primary health care settings in Serbia. Methods: This 6-month, observational, noninterventional study, followed 346 insulin-treated diabetes patients (type 1 diabetes [T1D], n = 57; type 2 diabetes [T2D], n = 289) from 28 primary care centers. Patients attended a 10-day course at the specialized educational center and were followed monthly by their primary care physicians. Patients used a simple paper tool to document 3-day, 7-point glucose profiles prior to each monthly clinic visit. Physicians reviewed the completed forms at each visit and used a standardized education program to provide remedial training. Changes in HbA1c levels, SMBG frequency, metabolic risk factors, and Diabetes Distress Scale (DDS) were assessed. Results: Mean (± SD) HbA1c within the full cohort was significantly improved from baseline at 6 months (8.85 ± 1.17% vs 7.91 ± 1.24%, P < .01). Significant increases in average SMBG frequency per week were seen at 6 months versus baseline (14.6/week vs 4.3/week, P < .001). The mean (± SE) number of hospitalizations due to metabolic conditions was significantly lower during the 6-month study compared to the 6-month period prior to the study (0.14 ± 0.04 vs 0.59 ± 0.09). DDS scores decreased from 39.6 ± 13.9 to 33.9 ± 14.5, P < .01. Conclusion: The use of structured SMBG combined with intensive education was associated with clinically significant reductions in HbA1c, increased SMBG frequency, and improved quality of life.

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The Impact of Shift Work on Diabetes Self-Management Activities

Journal of Doctoral Nursing Practice ◽

10.1891/2380-9418.12.1.66 ◽

2019 ◽

Vol 12 (1) ◽

pp. 66-72

Author(s):

Daniel J. Navarro ◽

Patricia T. Alpert ◽

Chad Cross

Keyword(s):

Physical Activity ◽

Primary Care ◽

Blood Glucose ◽

Shift Work ◽

Diabetes Care ◽

Night Shift ◽

Blood Glucose Control ◽

Self Management ◽

Shift Workers ◽

The Impact

BackgroundOnce a person is diagnosed with diabetes, aggressive management is imperative to minimize poor glycemic control devastating outcomes. However, for some patients reaching optimum blood glucose levels is challenging due to the complexity of diabetes care. To achieve good blood glucose control, patients affected by diabetes must engage in self-care activities that include routine blood glucose check, dietary control, physical activity, medication regimen, and routine medical provider visits. Diabetes-associated self-care activities aimed to reach good blood glucose control can be hindered by multiple factors including shift work.ObjectiveTo evaluate self-management activities of individuals affected by diabetes who are employed as shift workers. This study also informs primary care nurse practitioners of the challenges shift workers face in managing their disease.MethodsThis was a cross-sectional descriptive study. Participants were individuals affected by type II diabetes from a single primary care practice (N = 86); 45 were individuals working on the dayshift and 41 worked on the evening/night shift. Each participant completed the diabetes self-management questionnaire and author-developed demographic/supplemental questionnaire.ConclusionsThere were no differences in self-reported diabetes management activities (i.e., physical activity, glucose management, and healthcare use) between the two groups. Thirty-nine percent of participants working shifts reported worse sleep patterns compared to their dayshift counterparts (X2[1, N = 85] = 8.73, p = .003). Evening/night shift workers also reported more symptoms such as leg pain, fungal infection, numbness of the feet and legs, dizziness, and vision changes (X2[1, N = 79] = 43.037, p < .001).Implications for PracticeA better understanding of the impact that shift work has on diabetes care may help healthcare providers formulate meaningful treatment plans to meet the needs of evening/night shift diabetic workers. The use of a patient-centered medical home is one strategy.

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Comparison of Different Models of Diabetes Care on Compliance with Self-Monitoring of Blood Glucose by Memory Glucometer

Diabetes Care ◽

10.2337/diacare.11.9.719 ◽

1988 ◽

Vol 11 (9) ◽

pp. 719-724 ◽

Cited By ~ 12

Author(s):

P. L. Hoskins ◽

J. B. Alford ◽

D. J. Handelsman ◽

D. K. Yue ◽

J. R. Turtle

Keyword(s):

Blood Glucose ◽

Diabetes Care ◽

Self Monitoring

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System Accuracy Evaluation of 43 Blood Glucose Monitoring Systems for Self-Monitoring of Blood Glucose according to DIN EN ISO 15197

Journal of Diabetes Science and Technology ◽

10.1177/193229681200600510 ◽

2012 ◽

Vol 6 (5) ◽

pp. 1060-1075 ◽

Cited By ~ 147

Author(s):

Guido Freckmann ◽

Christina Schmid ◽

Annette Baumstark ◽

Stefan Pleus ◽

Manuela Link ◽

...

Keyword(s):

Blood Glucose ◽

Glucose Monitoring ◽

Blood Glucose Monitoring ◽

Monitoring Systems ◽

Accuracy Evaluation ◽

Self Monitoring

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Compliance to self-monitoring of blood glucose among patients with type 2 diabetes mellitus and its influential factors: a real-world cross-sectional study based on the Tencent TDF-I blood glucose monitoring platform

mHealth ◽

10.21037/mhealth.2017.06.01 ◽

2017 ◽

Vol 3 ◽

pp. 25-25 ◽

Cited By ~ 3

Author(s):

Zhi-De Hu ◽

Kai-Ping Zhang ◽

Ying Huang ◽

Shu Zhu

Keyword(s):

Blood Glucose ◽

Glucose Monitoring ◽

Cross Sectional Study ◽

Influential Factors ◽

Blood Glucose Monitoring ◽

Sectional Study ◽

Cross Sectional ◽

Self Monitoring ◽

Monitoring Platform

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The Impact of Primary Care Providers’ Bias on Depression Screening for Lesbian Women

Health Promotion Practice ◽

10.1177/15248399211066079 ◽

2021 ◽

pp. 152483992110660

Author(s):

Shuying Sha ◽

Mollie Aleshire

Keyword(s):

Primary Care ◽

Statistical Tests ◽

Secondary Analysis ◽

Primary Care Providers ◽

Depression Screening ◽

Lesbian Women ◽

Care Providers ◽

Explicit Bias ◽

Implicit And Explicit ◽

The Impact

Primary care providers’ (PCPs) implicit and explicit bias can adversely affect health outcomes of lesbian women including their mental health. Practice guidelines recommend universal screening for depression in primary care settings, yet the guidelines often are not followed. The intersection of PCPs’ implicit and explicit bias toward lesbian women may lead to even lower screening and diagnosis of depression in the lesbian population than in the general population. The purpose of this secondary analysis was to examine the relationship between PCPs’ implicit and explicit bias toward lesbian women and their recommendations for depression screening in this population. PCPs ( n = 195) in Kentucky completed a survey that included bias measures and screening recommendations for a simulated lesbian patient. Bivariate inferential statistical tests were conducted to compare the implicit and explicit bias scores of PCPs who recommended depression screening and those who did not. PCPs who recommended depression screening demonstrated more positive explicit attitudes toward lesbian women ( p < .05) and their implicit bias scores were marginally lower than the providers who did not recommend depression screening (p = .068). Implications for practice: Depression screening rates may be even lower for lesbian women due to implicit and explicit bias toward this population. Training to increase providers’ awareness of bias and its harm is the first step to improve primary care for lesbian women. Policies must protect against discrimination based on sexual orientation or gender identity.

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Hybrid Closed-Loop System Achieves Optimal Perioperative Glycemia in a Boy With Type 1 Diabetes: A Case Report

Frontiers in Pediatrics ◽

10.3389/fped.2021.625390 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jesus Dominguez-Riscart ◽

Nuria Buero-Fernandez ◽

Ana Garcia-Zarzuela ◽

Fernando A. Marmolejo-Franco ◽

Ana C. Perez-Guerrero ◽

...

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Insulin Infusion ◽

Closed Loop ◽

Total Duration ◽

Blood Glucose Monitoring ◽

Medical Team ◽

The Family ◽

The Impact

The goal in type 1 diabetes (T1D) therapy is to maintain optimal glycemic control under any circumstance. Diabetes technology is in continuous development to achieve this goal. The most advanced Food and Drug Administration- and European Medicines Agency-approved devices are hybrid closed-loop (HCL) systems, which deliver insulin subcutaneously in response to glucose levels according to an automated algorithm. T1D is frequently encountered in the perioperative period. The latest international guidelines for the management of children with diabetes undergoing surgery include specific adjustments to the patient's insulin therapy, hourly blood glucose monitoring, and intravenous (IV) insulin infusion. However, these guidelines were published while the HCL systems were still marginal. We present a case of a 9-year-old boy with long-standing T1D, under HCL system therapy for the last 9 months, and needing surgery for an appendectomy. We agreed with the family, the surgical team, and the anesthesiologists to continue HCL insulin infusion, without further adjustments, hourly blood glucose checks or IV insulin, while monitoring closely. The HCL system was able to keep glycemia within range for the total duration of the overnight fast, the surgery, and the initial recovery, without any external intervention or correction bolus. This is, to the best of our knowledge, the first reported pediatric case to undergo major surgery using a HCL system, and the results were absolutely satisfactory for the patient, his family, and the medical team. We believe that technology is ripe enough to advocate for a “take your pump to surgery” message, minimizing the impact and our interventions. The medical team may discuss this possibility with the family and patients.

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