The Impact of Self Glucose Monitoring on Diabetes Treatment Goals

Transcript

Eden Miller, DO: One thing with self-monitoring blood glucose [SMBG] is how we impact control. If we have a patient doing a 1-time-a-day testing, depending on the intervention they’re on, giving us this self-monitoring blood glucose report through the app allows the patient to be mindful of their numbers and how their lifestyle impacts them. We see that. Food choices, lifestyle. Also, [there’s better] engagement in medication. If you see a pattern or reports that you may have skipped a dose of the medication, sometimes patients will bring that up to me. They’ll say, “I noticed this glycemic effect.”

In addition, many prescribers—those of us who are on the other side with the pen and pad for the prescription—are starting to understand that there are specific interventional opportunities. But if you’re blinded to the data, if you’re not aware of what the SMBG data are, how do you know how to intervene? Is it a fasting problem in the morning? Is it a mealtime problem? Being familiar with the individualized data allows us, as clinicians, to sometimes de-intensify therapy. We’re not always talking about intensifying therapy. Sometimes it’s de-intensifying therapy because of a risk of hypoglycemia. Or as I like to call it, I take from 1 area of intervention and deposit in a different area. Maybe I’m overdoing it at a particular time of the day, causing unexpected hypoglycemia. I want to deposit that intervention in an area where hyperglycemia predominates. This is why the clinician—as you get more familiar with all forms of glucose data, regardless of what level it’s in—is trying to understand those patterns, so you can prescribe very purposefully for that individual and what they need at that level of their care. That’s where the data go further for the prescriber especially.

Elizabeth Holt, MD, FACE: In addition to the prescriber looking at and getting knowledge from the data, it’s important for the patients to do the same thing. They can look in the app and at their reports, see their averages, look for patterns, and think about what they’re doing that’s impacting their diabetes and what changes they might be able to make. They’re with their health care professional for only a few minutes out of the year. More than 99% of the time they’re on their own, so any support they can get outside the doctor’s office will help them better manage their disease.

Eden Miller, DO: You bring up a very good point, Dr Holt. One of the things I do in any realm of monitoring glucose, is I try to have the patient be aware of the effects or even journal them. I often say that your glucose is what you did 2 hours ago. I don’t want a novel, but write a notation of what you did. Did you go to work? Were you stressed? I had this most amazing discussion with an individual who would check their glucose in the middle of the night, and it was over 300 mg/dL. I was chiding her a bit about raiding the refrigerator in the middle of the night. She says, “I notice it on nights when I take care of my mother, who’s on hospice care.” I said, “My goodness, you are seeing the effect of stress. You’re seeing the effect that stress has on your blood sugar.” Many of us clinicians hardly ever have conversations of how you think we can impact this. We give recommendations of dietary things, but are they getting through to the patient? The other thing is that we’re learning. I’m not saying that it’s a great exception, but certain foods bother certain people and others don’t. Even being acutely aware of your individualized lifestyle interventions and how they affect you is that empowerment of the patient that we’re looking for.

Transcript edited for clarity.