As a blogger (conditioned for instant gratification!) I feel like I've been waiting forever, but the research article I prepared for the American Diabetes Association's Spring 2013 Diabetes Spectrum journal has finally been published. It's odd to see my name in that teeny-tiny academic-journal print.
The deal is that accomplished CDE Mary Austin approached me at last year's big annual ADA conference to ask if I'd be willing to tackle a research project/article on patient perspectives on self-monitoring of glucose. Turns out she was assigned as Guest Editor of this particular edition, and my piece should focus on the relative value of frequent glucose monitor use by type 2 patients -- which is quite controversial, actually. Which I always thought was kind of insane...
Here we have these amazing tools to get an immediate understanding of where our blood glucose stands, and some authorities are saying that using these tools has no value?! Some experts say frequent testing by type 2s is not necessary, and that the meter companies just push it to make more money. Really?
I understand that frequent glucose checks are much more critical for folks on insulin, but why shouldn't type 2s be able to improve their care using these tools as well? Push-back could be a money-saving tactic by insurers who don't want to cover costly test strips... Or the evidence of "little impact" could be due to the fact that the majority of type 2s are never told how to interpret or act on the results (d'oh!) In any case, there's lots of research, but very little evidence of what patients actually think about this topic. That's where I came in...
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With the help of Alliance Health Networks, we conducted an online survey of 732 patients residing on the patient community site DiabeticConnect.com in early September 2012. Respondents were queried about the extent of training they received on using a glucose meter, their satisfaction with this training, how they employ their meters, and their general thoughts and feelings about SMBG (self-monitoring of blood glucose).
The survey contained 16 multiple-choice questions with ample area for adding additional answers and personal comments. The questions pertained to how respondents obtained a meter, who trained them to use it and to what extent, how often and in what ways they (and their healthcare team) currently use their meter, and various queries as to how they feel about the testing experience and the meter results. Patients were also asked what the perceived value of testing is for them, and what they would most like to learn about home glucose monitoring if further training were available.
In addition to the numerical data, a total of 4,633 reader comments were gathered in response to 12 open-ended questions.
And guess what? Patients are frustrated. They have negative feelings about the whole diabetes thing. They are not "non-compliant" by choice, per our formal conclusions:
Our data indicates significant motivation among patients to learn to use their meters in a productive way — to identify and treat highs and lows, and to make meaningful lifestyle changes. However, there is a great deal of frustration over lack of useful meter training.
Comments indicate that this frustration extends to a more general sense of inattention and lack of empathy from healthcare providers, and to a common lack of the financial means to make the most of using these tools.
While earlier studies have shown that more frequent SMBG use was linked to more frequent congratulations and helpful feedback from healthcare providers, our survey appears to indicate that positive feedback from healthcare providers is sorely lacking.
Earlier studies have also concluded that "there was no significant evidence available that SMBG had an effect on patient satisfaction, general well-being or general health-related quality of life." While our study did not tap into the larger picture of quality of life, it does indicate that glucose testing itself is often a negative experience for patients no matter how well-trained they feel.
Comments gathered indicate that patients would appreciate more emphasis on using glucose meters as proactive tools, rather than being viewed as a means to "discovering mistakes."
A lack of satisfactory patient education appears to be contributing to a self-fulfilling prophecy: the notion that SMBG is not useful among persons with type 2 diabetes, or is useful only among patients taking insulin or other glucose-lowering medications that increase the risk of hypoglycemia.
Because I do not write in academic style (by choice!), my article got downgraded to an "editorial" piece, rather than a full research article -- but I did manage to obtain permission to publish the full, original article here at the 'Mine. Check it out:
Or view it in a downloadable Scribd version here
As a highlight, I thought you'd all enjoy this selection of input we received:
Got opinions about the value of "SMBG" for people living with type 2 diabetes who are not on insulin? Love to hear from you...