Implications of remote monitoring Technology in Optimizing Traditional Self-Monitoring of blood glucose in adults with T2DM in primary care.

MedStar author(s):
Citation: BMC Endocrine Disorders. 21(1):222, 2021 Nov 10.PMID: 34758807Institution: MedStar Diabetes Institute | MedStar Health Research Institute | MedStar Washington Hospital CenterForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Blood Glucose Self-Monitoring/mt [Methods] | *Diabetes Mellitus, Type 2/th [Therapy] | *Primary Health Care | *Telemetry/mt [Methods] | Aged | Blood Glucose | Diabetes Mellitus, Type 2/me [Metabolism] | Female | Glycated Hemoglobin A/me [Metabolism] | Humans | Hypoglycemia/ci [Chemically Induced] | Hypoglycemia/ep [Epidemiology] | Hypoglycemia/me [Metabolism] | Hypoglycemic Agents/tu [Therapeutic Use] | Insulin/tu [Therapeutic Use] | Male | Middle Aged | Non-Randomized Controlled Trials as Topic | Telemedicine | Time FactorsYear: 2021Local holdings: Available online from MWHC library: 2001 - presentISSN:
  • 1472-6823
Name of journal: BMC endocrine disordersAbstract: BACKGROUND: Self-monitoring of blood glucose (SMBG) has been shown to reduce hemoglobin A1C (HbA1C). Accordingly, guidelines recommend SMBG up to 4-10 times daily for adults with type 2 diabetes (T2DM) on insulin. For persons not on insulin, recommendations are equivocal. Newer technology-enabled blood glucose monitoring (BGM) devices can facilitate remote monitoring of glycemic data. New evidence generated by remote BGM may help to guide best practices for frequency and timing of finger-stick blood glucose (FSBG) monitoring in uncontrolled T2DM patients managed in primary care settings. This study aims to evaluate the impact of SMBG utility and frequency on glycemic outcomes using a novel BGM system which auto-transfers near real-time FSBG data to a cloud-based dashboard using cellular networks.CONCLUSIONS: Adults with uncontrolled T2DM achieved significant HbA1C improvement performing just 1.5 FSBGs daily during a technology-enabled diabetes care intervention. Among the 40% taking insulin, this improvement was achieved with a lower FSBG frequency than guidelines recommend. For those not on insulin, despite a lower frequency of FSBG, they achieved a greater reduction in A1C compared to patients on insulin. Low frequency FSBG monitoring pre-breakfast and post-dinner can potentially support optimization of glycemic control regardless of insulin status in the primary care setting.METHODS: Secondary analysis of the intervention arm of a comparative non-randomized trial with propensity-matched chart controls. Adults with T2DM and HbA1C > 9% receiving care in five primary care practices in a healthcare system participated in a 3-month diabetes boot camp (DBC) using telemedicine and a novel BGM to support comprehensive diabetes care management. The primary independent variable was frequency of FSBG. Secondary outcomes included frequency of FSBG by insulin status, distribution of FSBG checks by time of day, and hypoglycemia rates.RESULTS: 48,111 FSBGs were transmitted by 359 DBC completers. Participants performed 1.5 FSBG checks/day; with 1.6 checks/day for those on basal/bolus insulin. Higher FSBG frequency was associated with greater improvement in HbA1C independent of insulin treatment status (p = 0.0003). FSBG frequency was higher in patients treated with insulin (p = 0.003). FSBG checks were most common pre-breakfast and post-dinner. Hypoglycemia was rare (1.2% < 70 mg/dL).TRIAL REGISTRATION: Trial registration number: NCT02925312 (10/19/2016). Copyright (c) 2021. The Author(s).All authors: Gann K, Magee MF, Montero AR, Nassar CM, Toro-Tobon D, Youssef GAOriginally published: BMC Endocrine Disorders. 21(1):222, 2021 Nov 10.Fiscal year: FY2022Digital Object Identifier: Date added to catalog: 2022-01-25
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 34758807 Available 34758807

Available online from MWHC library: 2001 - present

BACKGROUND: Self-monitoring of blood glucose (SMBG) has been shown to reduce hemoglobin A1C (HbA1C). Accordingly, guidelines recommend SMBG up to 4-10 times daily for adults with type 2 diabetes (T2DM) on insulin. For persons not on insulin, recommendations are equivocal. Newer technology-enabled blood glucose monitoring (BGM) devices can facilitate remote monitoring of glycemic data. New evidence generated by remote BGM may help to guide best practices for frequency and timing of finger-stick blood glucose (FSBG) monitoring in uncontrolled T2DM patients managed in primary care settings. This study aims to evaluate the impact of SMBG utility and frequency on glycemic outcomes using a novel BGM system which auto-transfers near real-time FSBG data to a cloud-based dashboard using cellular networks.

CONCLUSIONS: Adults with uncontrolled T2DM achieved significant HbA1C improvement performing just 1.5 FSBGs daily during a technology-enabled diabetes care intervention. Among the 40% taking insulin, this improvement was achieved with a lower FSBG frequency than guidelines recommend. For those not on insulin, despite a lower frequency of FSBG, they achieved a greater reduction in A1C compared to patients on insulin. Low frequency FSBG monitoring pre-breakfast and post-dinner can potentially support optimization of glycemic control regardless of insulin status in the primary care setting.

METHODS: Secondary analysis of the intervention arm of a comparative non-randomized trial with propensity-matched chart controls. Adults with T2DM and HbA1C > 9% receiving care in five primary care practices in a healthcare system participated in a 3-month diabetes boot camp (DBC) using telemedicine and a novel BGM to support comprehensive diabetes care management. The primary independent variable was frequency of FSBG. Secondary outcomes included frequency of FSBG by insulin status, distribution of FSBG checks by time of day, and hypoglycemia rates.

RESULTS: 48,111 FSBGs were transmitted by 359 DBC completers. Participants performed 1.5 FSBG checks/day; with 1.6 checks/day for those on basal/bolus insulin. Higher FSBG frequency was associated with greater improvement in HbA1C independent of insulin treatment status (p = 0.0003). FSBG frequency was higher in patients treated with insulin (p = 0.003). FSBG checks were most common pre-breakfast and post-dinner. Hypoglycemia was rare (1.2% < 70 mg/dL).

TRIAL REGISTRATION: Trial registration number: NCT02925312 (10/19/2016). Copyright (c) 2021. The Author(s).

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