Remind Patients To Bring Glucose Meters to Visits
Two-Thirds of Patients Do Not Bring Glucose Meters to Office Visits
Less than one-third of patients with diabetes in a recent retrospective study brought their glucose meters to office visits. Among patients with poorly controlled diabetes, monitoring glucose levels at home and bringing glucose meters to appointments appeared to be associated with improved diabetes control among Medicare/Medicaid patients with high hemoglobin A1C levels, but further research is needed to confirm this finding, the study authors reported at The Endocrine Society’s 95th Annual Meeting, June 15-18 in San Francisco, CA.
“We hope this study gives a better understanding of how few patients are actually bringing in reliable self-monitored blood glucose (r-SMBG) data to their appointments, so that we can have realistic expectations for our patients at provider visits,” said lead author Gillian Boyd-Woschinko, MD, who was Chief Endocrine Fellow at the Icahn School of Medicine at Mount Sinai in New York. Dr. Boyd-Woschinko has since graduated and is now in private practice.
Retrospective Chart Review
The findings are based on a retrospective chart review of 500 patients with type 1 (10%) or type 2 diabetes (90%) who were commercially insured or received Medicare/Medicaid. No intervention was used to specifically encourage self-monitoring. Overall, 30% of patients provided r-SMBG data (via glucose meters) to their visit, with no difference of insurance type reported. The researchers found similar results when they included in the analysis a small number of patients who kept written logs of their glucose levels.
Among patients receiving Medicare/Medicaid with poorly controlled diabetes (A1c >8.0%), r-SMBG data were linked to a 1.2% decrease in mean A1C. This improvement was not found among commercially insured patients at any A1C range. “This [association] could be a marker of improved compliance, or the act of sharing data with providers itself could lead to better results,” Dr. Boyd-Woschinko explained.
While it is unclear how many patients in this study owned glucose monitors and/or were told to monitor glucose levels at home and bring in their data to office visits, co-author Ronald Tamler, MD, PhD, CDE, said it is safe to assume that all patients were told to do so “since our diabetologists are uniformly trained and uniformly will prescribe glucose meters (and will always ask about patients’ meters, so that they can write for a replacement).” Dr. Tamler is Clinical Director of the Mount Sinai Diabetes Center in New York.
Commentary on the Findings
“It is interesting that there is no difference between the two insurance populations in terms of how often they are showing up to medical appointments with blood glucose data,” William H. Polonsky, PhD, CDE, told DiabeticLifestyle.com, explaining that the two populations may be paying substantially different amounts for glucose test strips, which one might expect would influence patients’ abilities and willingness to test and share blood glucose data.
The finding of a potential relationship between r-SMBG and A1C is interesting, but more research is needed to determine what the causal direction, if any, might be, said Dr. Polonsky, who is Founder and President of the Behavioral Diabetes Institute, and Associate Clinical Professor in Psychiatry at the University of California San Diego. A limitation of the study is that it is not known when or why blood glucose monitoring may have been initiated and, therefore, the recent change in A1C levels cannot be directly linked to its use, Dr. Polonsky said.
Why Don’t Patients Self-Monitor Glucose Levels?
Dr. Polonsky noted health care providers are often frustrated that their patients are seemingly uncooperative with monitoring recommendations, and said it is evident why patients are not complying. “Many patients, especially those with type 2 diabetes, don’t know what to do with these data, and their physicians don’t make use of patients’ blood glucose data in a way that is encouraging, supportive, and helpful,” said Dr. Polonsky.
“Our recent study showed that many patients with type 2 diabetes think that blood glucose monitoring is a waste of time and merely a way for physicians to blame them for ‘misbehaving.’ They view blood glucose monitoring as something to be avoided, because the numbers make little sense to them and the data are too often used by health care professionals as a means to critique or punish them,” Dr. Polonsky said, referencing his recent study published in Diabetic Medicine. Likewise, “It is a shame because blood glucose data really can be valuable, especially when it becomes a collaborative effort between patients and physicians,” he said.
Implications for Daily Practice
“Reminding patients to check their sugar and to bring this data to appointments is a burden for both patients and providers,” Dr. Boyd-Woschinko said. To ease this communication “there are Websites, smart phone apps, and other mobile health programs that allow patients to record blood glucose data, or even upload it directly from their glucose meter and share with providers. The key is making patients aware of these alternative ways of recording data and giving them incentives to be more compliant with SMBG measurement,” she said.