Type 1 Diabetes Glucose Control related Home-Based Testing: A Mini-Review of Tools and Patient Knowledge and Implementation

Abstract

Background:In Type 1 diabetes (T1D) glycaemic control is key to the prevention of acute and chronic complications. An increasing array of devices is available for at-home monitoring. Tools must be used appropriately, and the information gained utilised well to maximise clinical benefit. Aims: This mini-review describes clinically available home glucose and ketone monitoring tools and discusses factors which impact glucose outcomes. Additionally, findings from the authors' surveys of T1D adults regarding glucose self-care are discussed.Results: Blood glucose strips and meters and urine glucose strips have been available for decades. More recently available are continuous glucose monitors (CGM) and flash glucose monitoring (FGM) which assess interstitial fluid glucose levels. Blood and urine ketone test-strips are also available. In surveys of adults with T1D in two tertiary referral diabetes clinics (n=205) and in general practice (GP, n=35) self-reported rates of blood glucose (BG) monitoring and glucose targets were similar, with a mean (SD) of 5.3 (2.5) tests/day. Deficits in knowledge or practice related to the care of hypothetical pre-bed BG levels and of metabolic control around illness, exercise or alcohol were common. Only about one third reported treating nocturnal hypoglycaemia with the recommended refined then complex carbohydrate. Only 66% reported having in-date ketone teststrips at home. Further education was often desired, but difficult to predict based on demographics.Conclusions: A range of tools are available to test glucose and ketone levels at home. Many adults with T1D have suboptimal knowledge and behaviour regarding glucose self-management.

Update on technologies, medicines and treatments

“…However, many people do not have a supply of ketone testing strips, either for blood or urine testing. A survey of 205 people with type 1 diabetes in Australia found that 34% of respondents did not have an in‐date ketone test kit 1 . This is worrying, not only because of the risk of death through DKA but because the cost of hospitalizations due to DKA is over £2000 per episode 2 .…”