Commentary by Jenise C. Wong, MD, PhD and Maureen Monaghan, PhD
“Adults and families of children with type 1 diabetes could benefit from downloading and reviewing data from their diabetes devices to adjust their insulin doses and to look at the effect of changes in their activity and diet on their blood glucose levels over time,” said lead author Jenise C. Wong, MD, PhD. “However, most patients are not doing this routinely, and many don’t do this at all,” Dr. Wong said.
“This retrospective data review is most often neglected in caregivers of adolescents and in young adults,” Dr. Wong said. “Obstacles to downloading and reviewing data include not perceiving a need to review the data, not knowing how to do it, technical problems, and frustration with the available hardware and software for acquiring and viewing the data,” she added.
“Routine review of glucose data provides an excellent opportunity for identifying patterns in blood glucose levels and fine-tuning diabetes management,” commented Maureen Monaghan, PhD, Assistant Professor, Department of Psychiatry & Behavioral Sciences, Children's National Health System, Washington, DC. “The main finding of this study is that the majority of patients—even users of advanced technologies such as insulin pumps and continuous glucose monitors—are not taking advantage of the ability to download and review glucose data at home,” Dr. Monaghan said.
“As suggested by study results, even infrequent retrospective review of glucose data may lead to better glycemic control,” Dr. Monaghan said. “While many patients may review data by scrolling through their meter, there is a significant benefit to reviewing downloaded glucose data over a longer period of time and utilizing graphs and charts to identify trends,” she added.
A total of 155 adults and 185 caregivers of children with type 1 diabetes completed electronic surveys on their use of glucose meters, insulin pumps, and/or continuous glucose monitoring devices.
As shown in the Table, few patients routinely downloaded data or reviewed data from diabetes devices. Routine reviewers of device data had significantly lower hemoglobin A1C levels compared with nonroutine reviewers (7.2% vs. 8.1% in adults [P=0.03]; 7.8% vs. 8.6% in children [P=0.001]). In adult participants, older age and greater duration of diabetes were significant predictors of being a routine reviewer (P=0.02 and P=0.01, respectively).
“Given the current tools that we have now, patients and families need education not only on the logistics of how to download and view data from their diabetes devices, but also on how to make sense of the data,” Dr. Wong said. “Diabetes providers should work with patients and families to help them understand what the data mean and how they can use it to make informed decisions about changing insulin doses, using advanced features of their devices, or making other adjustments in their diabetes management. This type of education is important in helping patients achieve safe and successful diabetes self-management,” Dr. Wong noted.
Tips for Counseling Patients
“First, health care providers should educate patients and families on the technical and logistic aspects of downloading device data both at device initiation and through continued education either in clinic visits or more formal education,” Dr. Wong said. “Providers can download patients’ device data during clinic encounters, explain to patients how they look for patterns in the data, and describe how they use the data to make changes in various parts of the insulin plan,” she said.
“Barriers to home downloading in this study were primarily logistical, with participants reporting a lack of knowledge and/or supplies,” Dr. Monaghan commented. “Health care providers can likely increase the frequency of home downloading through relatively simple means, including providing cables to download devices, demonstrating downloading techniques in clinic, and helping patients determine how to best interpret and utilize downloaded data,” she said.
“Health care providers can help patients identify optimal intervals to review data and ways to avoid ‘data overload.’ Data downloads can be used infrequently as a quick check-in of diabetes management, to problem solve unexpected changes in glycemic control, or in response to major changes in insulin dosing, regimen, or daily routines. For example, patients may benefit from downloading and reviewing glucose data if they are starting a new exercise routine or taking a new medication,” Dr. Monaghan said.
“In our study, we provided families with a step-by-step handout for how to download their specific device,” Dr. Monaghan noted, referring to her study of a physician-delivered intervention to increase parent-adolescent communication about glucose monitoring. “Physicians also explicitly discussed the benefits of periodically reviewing glucose data and how to fit review of glucose data into patients’ regular routines. This conversation was appreciated by families and reinforced that routine review of glucose data is an integral part of diabetes self-care,” Dr. Monaghan said.
“In order to help patients and families download, review, understand, and use their diabetes data, we need more research on the barriers to doing this at the present time,” Dr. Wong concluded. “Understanding current perceptions, barriers, and facilitators to reviewing data will assist in improving our education strategies. We would also benefit from improved tools (hardware and software) to more seamlessly acquire and view the data. These new educational and technological interventions should then be studied for patient and provider feasibility and acceptance, as well as for their efficacy at improving behavioral, psychosocial, and clinical diabetes outcomes,” she told EndocrineWeb.
Wong JC, Neinstein AB, Spindler M, Adi S. A minority of patients with type 1 diabetes routinely downloads and retrospectively reviews device data. Diabetes Technol Ther. 2015;17(8):555-562.
Monaghan M, Clary L, Mehta P, et al. Checking in: a pilot of a physician-delivered intervention to increase parent-adolescent communication about blood glucose monitoring. Clin Pediatr (Phila). 2015 Apr 20. pii: 0009922815581833. [Epub ahead of print]