Self-monitoring of blood glucose in insulin-treated diabetes: a multicase study

The Importance of Patient and Family Engagement, the Needs for Self-Monitoring of Blood Glucose (SMBG) - Our Perspectives Learned Through a Story of SMBG Assistive Devices Made by a Husband of the Patient with Diabetes

Despite some negative reports regarding the need for the self-monitoring of blood glucose (SMBG), including the issue of cost-effectiveness, there are still many users, and in diabetes treatment, which is largely dependent on the patient's self-care, SMBG remains an important tool in establishing such self-care habits, with several reports supporting this notion. In addition, devices are needed to assist in SMBG for patients with diabetes who have difficulty performing SMBG, such as the elderly or those with visual impairment. In current diabetes care, it is reported that patient-centered care that respects the preferences, needs, and values of individual patients and personalized care that consider the characteristics and comorbidities of each patient are important. Through a case study of a patient with diabetes who had difficulty performing SMBG due to visual impairment, we learned of the needs of SMBG and its assistive devices and the importance of patient and family engagement with emphasis on patient-centered and personalized care. We herein report what we learned through this case in the form of perspectives. Through this report, we hope that medical professionals involved in diabetes care will learn of the importance and needs of these issues and apply them to their actual clinical practice.

The development of an intervention for diabetes prevention among people with impaired glucose regulation: feasibility and acceptability of an intervention component

Background

As part of the design process of a low-cost minimal-contact diabetes prevention intervention, we issued a blood glucose meter to people with impaired glucose regulation (who are at high risk of type 2 diabetes). We conducted a feasibility study to assess the acceptability of this intervention component and whether and how recipients engaged with it.

Methods

A blood glucose meter was given to 19 people identified through primary care, who were asked to use the meter in an exploratory way during a 4-week trial period, to try to understand the effect of different foods on the body. They were advised that they could test as often or as little as they liked and were also asked to keep a food/exercise diary for at least 1 week. They were interviewed about their experiences afterwards.

Results

There was a high level of engagement with testing, with the total number of tests recorded ranging from 11 to 114 (median 74) among 18 participants. Fifteen participants tested almost every day during the 4-week period. The cognitive engagement was more limited. All participants commented on their own results, and most were able to relate high or low results to foods eaten and exercise taken, usually in response to prompting. However, there was limited thought or understanding beyond this in terms of longer-term patterns of diet and exercise, and testing was routine rather than experimental. Some participants were confused by conflicting or unexpected results. A few minor problems were reported by participants, such as soreness, inconvenience, and difficulty in getting blood, but never enough to discontinue testing. Several participants stated that the meter was a useful aid as a reminder that they were at high risk of diabetes and served as a prompt that needed to make and/or maintain behaviour changes.

Conclusions

The study suggests that blood glucose monitoring is acceptable to people with impaired glucose regulation and that they would engage with it as part of an intervention to improve their diet. The study has also uncovered potential mechanisms of action for behaviour change.