Randomized trial of technology-assisted self-monitoring of blood glucose by low-income seniors: improved glycemic control in type 2 diabetes mellitus

Abstract

Self-monitoring of blood glucose (SMBG) has been recommended for people with type 2 diabetes mellitus. This trial tested an automated self-management monitor (ASMM) that reminds patients to perform SMBG, provides feedback on results of SMBG, and action tips for improved self-management. This delayed-start trial randomized participants to using the ASMM immediately (IG), or following a delay of 6 months (DG). Glycated hemoglobin (HgbA1c) level and survey data was collected at home visits every 3 months. 44 diabetic men and women, mean age 70, completed the 12-month trial. Baseline HgbA1c was 8.1 % ± 1.0, dropping to 7.3 ± 1.0 by 9 months, with a 3-month lag in the DG (F = 3.56, p = 0.004). Decrease in HgbA1c was significantly correlated to increased frequency of SMBG, R = 0.588, p < 0.01. Providing older diabetics with objective immediate contingent feedback resulted in more frequent SMBG that correlated with better glycemic control. This type of technology may provide real-time feedback not only to patient users, but to the health care system, allowing better integration of provider recommendations with patient-centered action.

Educational disparities in the associations between self‐monitoring of blood glucose and glycemic control in type 2 diabetes patients inXiamen,China

“…Self‐monitoring of blood glucose provides real‐time glucose measurements for the adjustment of insulin doses and diet and exercise regimens, and thus plays a critical part in diabetes management of insulin‐treated and non‐insulin‐treated patients . Moreover, SMBG can offer direct and intuitive feedback from patients’ lifestyle.…”

Educational disparities in the associations between self‐monitoring of blood glucose and glycemic control in type 2 diabetes patients inXiamen,China

“…Self‐monitoring of blood glucose provides real‐time glucose measurements for the adjustment of insulin doses and diet and exercise regimens, and thus plays a critical part in diabetes management of insulin‐treated and non‐insulin‐treated patients . Moreover, SMBG can offer direct and intuitive feedback from patients’ lifestyle.…”

Implementing a Digital-Enhanced Multiple-Behavior Self-Monitoring Intervention in Diabetes Care and Support: A Mixed-Method Evaluation of Patient Outcomes

“…[23][24][25][26][27] Furthermore, additional research indicates the usefulness and need for real-time, actionable feedback to patients via an app to mitigate barriers associated with lag time in receiving direct provider feedback. [28][29][30][31] The Science of Diabetes Self-Management and Care 52 (3) Although there were no group differences between the paper and smartphone self-monitoring groups, the study did show modest weight loss. As noted, A1C did not have significant change over the course of the study, but glycemic control was observed at baseline and 3 months.…”

The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials

“…Most studies employed a regular parallel-group design. Two studies were conducted using a delayed-start/semicrossover approach [ 23 , 48 ] and five studies employed a crossover design [ 8 , 11 , 14 , 24 , 27 ]. Of those five, two trials were judged to have a low risk of carryover, one studying an electronic vision enhancement system [ 24 ] and the other evaluating the benefit of video calls versus regular phone calls for patients with dementia [ 8 ].…”

“…Having a mean age ≥65 years as an inclusion criterion for our search, there were still large differences in the inclusion criteria at the study level: ≥18 years in three studies [ 13 , 14 , 24 ], 45-90 years in one study [ 17 ], 55-79 years in one study [ 49 ], ≥60 years in one study [ 11 ], and ≥65 years in six studies [ 7 , 23 , 50 - 53 ]. The other seven trials did not have age as an inclusion criterion but targeted conditions present specifically in older adults, such as cardiovascular conditions, dementia, or being a senior housing resident [ 6 , 8 , 12 , 22 , 27 , 48 , 54 ]. Table 1 provides the mean (SD) age for each study stratified by intervention and control group.…”

“…The 19 selected trials evaluated devices representing the following six domains: (1) mobility (n=5 [ 6 , 7 , 14 , 52 , 53 ]), (2) personal disease management (n=5 [ 13 , 22 , 48 , 51 , 54 ]), (3) medication (n=4 [ 12 , 17 , 27 , 50 ]), (4) mental support (n=2 [ 8 , 11 ]), (5) hearing (n=2 [ 23 , 49 ]), and (6) vision (n=1 [ 24 ]). All devices addressed at least one of the areas of autonomy, safety, or communication.…”

Educational disparities in the associations between self‐monitoring of blood glucose and glycemic control in type 2 diabetes patients inXiamen,China

“…Self‐monitoring of blood glucose provides real‐time glucose measurements for the adjustment of insulin doses and diet and exercise regimens, and thus plays a critical part in diabetes management of insulin‐treated and non‐insulin‐treated patients . Moreover, SMBG can offer direct and intuitive feedback from patients’ lifestyle.…”

Implementing a Digital-Enhanced Multiple-Behavior Self-Monitoring Intervention in Diabetes Care and Support: A Mixed-Method Evaluation of Patient Outcomes

“…[23][24][25][26][27] Furthermore, additional research indicates the usefulness and need for real-time, actionable feedback to patients via an app to mitigate barriers associated with lag time in receiving direct provider feedback. [28][29][30][31] The Science of Diabetes Self-Management and Care 52 (3) Although there were no group differences between the paper and smartphone self-monitoring groups, the study did show modest weight loss. As noted, A1C did not have significant change over the course of the study, but glycemic control was observed at baseline and 3 months.…”

The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials

“…Most studies employed a regular parallel-group design. Two studies were conducted using a delayed-start/semicrossover approach [ 23 , 48 ] and five studies employed a crossover design [ 8 , 11 , 14 , 24 , 27 ]. Of those five, two trials were judged to have a low risk of carryover, one studying an electronic vision enhancement system [ 24 ] and the other evaluating the benefit of video calls versus regular phone calls for patients with dementia [ 8 ].…”

“…Having a mean age ≥65 years as an inclusion criterion for our search, there were still large differences in the inclusion criteria at the study level: ≥18 years in three studies [ 13 , 14 , 24 ], 45-90 years in one study [ 17 ], 55-79 years in one study [ 49 ], ≥60 years in one study [ 11 ], and ≥65 years in six studies [ 7 , 23 , 50 - 53 ]. The other seven trials did not have age as an inclusion criterion but targeted conditions present specifically in older adults, such as cardiovascular conditions, dementia, or being a senior housing resident [ 6 , 8 , 12 , 22 , 27 , 48 , 54 ]. Table 1 provides the mean (SD) age for each study stratified by intervention and control group.…”

“…The 19 selected trials evaluated devices representing the following six domains: (1) mobility (n=5 [ 6 , 7 , 14 , 52 , 53 ]), (2) personal disease management (n=5 [ 13 , 22 , 48 , 51 , 54 ]), (3) medication (n=4 [ 12 , 17 , 27 , 50 ]), (4) mental support (n=2 [ 8 , 11 ]), (5) hearing (n=2 [ 23 , 49 ]), and (6) vision (n=1 [ 24 ]). All devices addressed at least one of the areas of autonomy, safety, or communication.…”

Educational disparities in the associations between self‐monitoring of blood glucose and glycemic control in type 2 diabetes patients inXiamen,China

“…Self‐monitoring of blood glucose provides real‐time glucose measurements for the adjustment of insulin doses and diet and exercise regimens, and thus plays a critical part in diabetes management of insulin‐treated and non‐insulin‐treated patients . Moreover, SMBG can offer direct and intuitive feedback from patients’ lifestyle.…”

Implementing a Digital-Enhanced Multiple-Behavior Self-Monitoring Intervention in Diabetes Care and Support: A Mixed-Method Evaluation of Patient Outcomes

“…[23][24][25][26][27] Furthermore, additional research indicates the usefulness and need for real-time, actionable feedback to patients via an app to mitigate barriers associated with lag time in receiving direct provider feedback. [28][29][30][31] The Science of Diabetes Self-Management and Care 52 (3) Although there were no group differences between the paper and smartphone self-monitoring groups, the study did show modest weight loss. As noted, A1C did not have significant change over the course of the study, but glycemic control was observed at baseline and 3 months.…”

The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials

“…Most studies employed a regular parallel-group design. Two studies were conducted using a delayed-start/semicrossover approach [ 23 , 48 ] and five studies employed a crossover design [ 8 , 11 , 14 , 24 , 27 ]. Of those five, two trials were judged to have a low risk of carryover, one studying an electronic vision enhancement system [ 24 ] and the other evaluating the benefit of video calls versus regular phone calls for patients with dementia [ 8 ].…”

“…Having a mean age ≥65 years as an inclusion criterion for our search, there were still large differences in the inclusion criteria at the study level: ≥18 years in three studies [ 13 , 14 , 24 ], 45-90 years in one study [ 17 ], 55-79 years in one study [ 49 ], ≥60 years in one study [ 11 ], and ≥65 years in six studies [ 7 , 23 , 50 - 53 ]. The other seven trials did not have age as an inclusion criterion but targeted conditions present specifically in older adults, such as cardiovascular conditions, dementia, or being a senior housing resident [ 6 , 8 , 12 , 22 , 27 , 48 , 54 ]. Table 1 provides the mean (SD) age for each study stratified by intervention and control group.…”

“…The 19 selected trials evaluated devices representing the following six domains: (1) mobility (n=5 [ 6 , 7 , 14 , 52 , 53 ]), (2) personal disease management (n=5 [ 13 , 22 , 48 , 51 , 54 ]), (3) medication (n=4 [ 12 , 17 , 27 , 50 ]), (4) mental support (n=2 [ 8 , 11 ]), (5) hearing (n=2 [ 23 , 49 ]), and (6) vision (n=1 [ 24 ]). All devices addressed at least one of the areas of autonomy, safety, or communication.…”