Actionable Self-Monitoring of Blood Glucose: Redefining the Role for Patients Using Multiple Daily Injection Therapy

Kerr, David; Messing, Rebecca; Resch, Ansgar

doi:10.1177/193229681100500635

Cited by 7 publications

(8 citation statements)

References 29 publications

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“…Personalised feedback is believed to make self-monitoring of clinical readings more actionable. 4 This is the mechanism that may have resulted in the encouraging trends observed in BP.…”

Section: Discussionmentioning

confidence: 99%

“…These make possible the tracking of self-monitoring data and receipt of personalised feedback, potentially facilitating pattern analysis, reinforcing health behaviours, and promoting goal-setting, action planning or problem-solving. 3–8 Many of these TH applications are now available for use on patients’ mobile-phones. 9 The added value of mobile TH (MTH) is that the recording, transmission and receipt of feedback can happen in any place, at any time and from a personal device already integrated into peoples’ lives.…”

Section: Introductionmentioning

confidence: 99%

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A randomised, controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in people with poorly controlled diabetes

2016

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This is the accepted version of the paper.This version of the publication may differ from the final published version. The objective of this research is to determine the effects of mobile telehealth (MTH) on glycosylated haemoglobin (HbA1c) and other clinical and patient-reported outcomes in insulin-requiring people with diabetes. Permanent repository link MethodsA nine-month randomised, controlled trial compared standard care to standard care supplemented with MTH (self-monitoring, mobile-phone data transmissions, graphical and nurse-initiated feedback, and educational calls). Clinical (HbA1c, blood pressure, daily insulin dose, diabetes outpatient appointments (DOAs)) and questionnaire data (health-related quality of life, depression, anxiety) were collected. Mean group changes over time were compared using hierarchical linear models and MannWhitney tests. ResultsEighty-one participants with a baseline HbA1c of 8.98% ± 1.82 were randomised to the intervention (n = 45) and standard care (n = 36). The Group by Time effect revealed MTH did not significantly influence HbA1c (p = 0.228), but p values were borderline significant for blood pressure (p = 0.054) and mental-health related quality of life (p = 0.057). Examination of effect sizes and 95% confidence intervals for mean group differences at nine months supported the existence of a protective effect of MTH on mental health-related quality of life as well as depression. None of the other measured outcomes were found to be affected by the MTH intervention. ConclusionsFindings from this study must be interpreted with caution given the small sample size, but they do not support the widespread adoption of MTH to achieve clinically significant changes in HbA1c. MTH may, however, have positive effects on blood pressure and protective effects on some aspects of mental health.

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“…Personalised feedback is believed to make self-monitoring of clinical readings more actionable. 4 This is the mechanism that may have resulted in the encouraging trends observed in BP.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A randomised, controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in people with poorly controlled diabetes

2016

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“…A literature review was conducted to support the health state content, focusing on diabetes symptoms [16][17][18][19][20], treatment, glucose monitoring, [11,13,[21][22][23][24][25], and the two glucose monitoring approaches represented in the health states [15,26]. Further information about the glucose monitoring devices was obtained from the instructions for use that accompanied each device [14,27].…”

Section: Health State Developmentmentioning

confidence: 99%

“…For diabetes, an important aspect of the treatment process is self-monitoring of glucose levels [10][11][12]. Regular evaluation of glucose levels can guide patients and health care providers when making treatment and lifestyle decisions.…”

Section: Introductionmentioning

confidence: 99%

Health State Utilities Associated with Glucose Monitoring Devices

Matza¹,

Stewart²,

Davies

et al. 2017

Value in Health

Self Cite

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The flash glucose monitoring system was associated with a significantly greater utility than the conventional monitoring system. This difference may be useful in cost-utility models comparing the value of glucose monitoring devices for patients with diabetes. This study adds to the literature on treatment process utilities, suggesting that time trade-off methods may be used to quantify preferences among medical devices.

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“…95 Technology can provide solutions for this: A systematic review of use of mobile phones to transmit data and send patients automated text/graphical or HCP feedback showed improved glycemic control in most studies, even those without HCP feedback, suggesting that this technology could be used to support self-management. 96 Bolus calculators also increase patients’ ability to use their SMBG results by providing “actionable advice” 97 empowering self-management. 98…”

Section: Addressing Barriers To Technology Use and Strategies To Optimentioning

confidence: 99%

Influences on Technology Use and Efficacy in Type 1 Diabetes

Franklin

2016

J Diabetes Sci Technol

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Since 1921 technology has existed to replace insulin and treat diabetes. Although a definitive link was established between HbA1c and complication risk over 20 years ago, 1 only a minority achieve HbA1c targets despite intensified insulin regimens and new technologies. 2 This narrative review focuses on how psychosocial functioning affects uptake and use of technologies and the impact of technology on psychosocial outcomes in adults and children with type 1 diabetes and their caregivers. It examines evidence from large meta-analyses to small qualitative studies which provide detailed insight into technology use. Self Monitoring of Blood GlucoseFrequent blood glucose testing should be a routine part of diabetes self-care 3,4 as it is integral to intensive insulin therapy 1 and improves glycemic control. 5 However, studies of adult patients reveal low testing frequency, 6,7 which is influenced by psychosocial factors, with increased testing in patients of older age, female gender, longer diabetes duration, on basal bolus therapy compared with less intensive regimens, with decreased hypoglycemic awareness, higher "fear of hypoglycemia" and positive self-care personality traits 6 and less testing in ethnic minorities, smokers, those with low education, 8 low income and language barriers. 7 In adolescents, testing is more frequent in younger age groups, higher social status, and higher self-efficacy and less frequent in those with lower self-esteem, high-stress life events, lower parental support, 9,10 from single parent, lower-income, and ethnic minorities, and when given self-care autonomy before reaching cognitive and social maturity.11 In children, family functioning 12 and parental education 13 predict adherence to diabetes self-management and glycemic control.Qualitative studies in adults show that some perceive selfmonitoring of blood glucose (SMBG) as a tool to achieve good control and a normal life, but others see SMBG as a 639315D STXXX10.1177/1932296816639315Journal of Diabetes Science and TechnologyFranklin AbstractThe majority of people with type 1 diabetes have suboptimal glycemic control, increasing their complication risk. Technology to support diabetes self-care has advanced significantly and includes self-monitoring of blood glucose (SMBG), insulin pump therapy (IPT), continuous glucose monitoring (CGM), and sensor-augmented pump therapy (SAPT), which are stepping stones toward the "artificial pancreas" using closed-loop technology. Use of these technologies improves clinical outcomes for patients with the appropriate skills and motivation. This review addresses the psychosocial factors that influence both technology provision and clinical outcome and also how technology impacts on psychological outcomes. Optimal use of the various diabetes self-management technologies is influenced by previous self-care behaviors, demographic and psychological factors. Provision of IPT is also influenced by the same factors. Despite technology increasing the complexity of treatment, the lack of evidence for adverse...

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Actionable Self-Monitoring of Blood Glucose: Redefining the Role for Patients Using Multiple Daily Injection Therapy

Cited by 7 publications

References 29 publications

A randomised, controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in people with poorly controlled diabetes

A randomised, controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in people with poorly controlled diabetes

Health State Utilities Associated with Glucose Monitoring Devices

Influences on Technology Use and Efficacy in Type 1 Diabetes

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