ICE/ENDO 2014: 16th International Congress of Endocrinology and The Endocrine Society's 96th Annual Meeting:

Use of Blood Glucose Self-Monitoring Devices by Adults With Type 1 Diabetes

Jenise Wong, MD, PhD, the study’s principal investigator stated, “These devices can be useful not only for real-time disease self-management but also in helping to review past data to guide future treatment decision making.” However, a large percentage of adults with type 1 diabetes never use their blood glucose self-monitoring devices to download historical data about their blood sugar levels and insulin doses.

Dr. Wong is Assistant Adjunct Professor of Pediatrics at the University of California, San Francisco. She presented the results of an important study at The Endocrine Society’s Annual Meeting held in Chicago during June 2014.

Type 1 Diabetes
In all types of diabetes, it is critical to maintain blood sugar within the normal range to mimic normal physiology and help prevent long-term complications. People with type 1 diabetes do not produce insulin at all and will always require prescription insulin to maintain normal blood sugar levels. Many of these patients utilize blood glucose self-monitoring devices to track blood sugar levels, carbohydrate intake, past insulin doses, and physical activity, as well as calculate and administer insulin doses.

Device Types
There are three devices that people with type 1 diabetes use: blood glucose meters, insulin pumps, and continuous glucose monitoring (CGM). Users typically use these devices for real-time functions. Dr. Wong explained, “A patient may decide to give a dose of insulin. Or the patient may give a dose of insulin for the carbohydrates they are about to eat, enter the carbs into their pump, and based on preprogrammed ratios, the pump suggests a dose. Or the display on their CGM may show their blood glucose level has been declining for the past few minutes, and the patient may decide to have a snack to prevent a low blood sugar event.”

Retrospective Functions
However, in addition to real-time functions, these devices provide retrospective functions.  The data from these devices can  be uploaded to a computer—data from the past few days, weeks, or months. The information is useful to detect patterns and determine an insulin plan. The healthcare provider and/or patient can pull the data interdependently. It is similar to reviewing a credit card statement at the end of the month; the patient can get an idea of where money is spent and plan for the future.

In Dr. Wong’s study, the retrospective functions of the device were of interest. She stated, “Our main question was, do people with type 1 diabetes regularly download and review the data from their diabetes devices at home? In short, the answer is no.”

The three main points from Dr. Wong’s study addressed the following:

  1. People with type 1 diabetes are not reviewing their device data at home.
  2. Why don’t they retrieve the data? Is it a lack of guidance, motivation, and/or because the data is difficult to obtain?
  3. Patients are in need of better tools and education to make the data from these devices more useable and actionable.

A cross-sectional survey of adults with type 1 diabetes showed the percentages of study participants who were using diabetic devices:

  • 97% were using handheld blood glucose meters.
  • 31% downloaded at least once in the past year.
  • 70% never downloaded any of the data, not even once during the past year.

Next, the study determined data download frequency. The American Diabetes Association guidelines defines this frequency as once between every regularly scheduled clinic visit—meaning four or more times per year.

  • Only 20% of adults with type 1 diabetes frequently downloaded data.
  • How many of the frequent downloaders review the data obtained? The study revealed only 12% reviewed their data.

Reviewing the patients who frequently reviewed their data, were there any particular characteristics that set them apart?

  • The older the participant and the longer they had type 1 diabetes, the more likely they were to frequently review their data.
  • This section of the study results were not influenced by the participant’s sex, ethnicity, insurance, or level of education.

Why don’t patients frequently download their data? Listed below are some of the results:

  • The diabetes healthcare provider did not encourage it; showing a lack of guidance.
  • The healthcare provider did not ask for the data.
  • Users’ lack of knowledge or having the right tools.
  • “I didn’t know I could do that.”
  •  “I don’t have the software.”
  •  “I have trouble downloading the data.”
  •  Some participants are not interested.

Concluding Comments
In Dr. Wong’s concluding comments, she said, “For those who frequently review their data, they did not have better glucose control, which we measured by the hemoglobin A1C in our study after we adjust for possible confounding factors.” Moving forward, Dr. Wong offered several suggestions:

  •  Improve the device hardware
  • Develop way(s) that seamlessly transfer data to the devices they do use (eg, smart phones).
  • Develop more user-friendly software.
  • Healthcare providers can find better ways to help patients work with their data—teach pattern recognition, dosing, and behavior based on the data.
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