Original ArticleDoes Availability of Reliable Home Blood Glucose Data at Diabetes Appointments Improve Glycemia?
Section snippets
INTRODUCTION
Diabetes poses a significant health burden, and the Center for Disease Control estimates that 25.8 million people in the United States have this condition (1). More than most diseases, diabetes requires active self-management to achieve adequate glycemic control (2). Structured blood glucose monitoring has been shown to lower hemoglobin A1C (A1C) by up to 1% in patients with type 1 and type 2 diabetes 3., 4., 5.. Self-monitored blood glucose (SMBG) data provide valuable information regarding
METHODS
Our study was approved by The Icahn School of Medicine at Mount Sinai Institutional Review Board. We conducted a retrospective review of 500 charts from The Mount Sinai Hospital Managed Medicare/Medicaid Diabetes Clinic (MDC) and Endocrinology Faculty Practice (FP) between January 1, 2012 and June 30, 2012. Charts were included from follow-up visits of established adult patients with a diagnosis of type 1 or type 2 diabetes. Due to altered glycemic targets, pregnant patients were excluded. A
RESULTS
Our sample of 500 charts was composed of 215 MDC patients (43%) and 285 FP patients (57%). Table 1 describes the baseline demographics of the sample. Overall, 297 patients (59.4%) were female, 181 (36%) were Hispanic, 152 (30%) were African American, and 106 (21%) were Caucasian. Approximately 10% of patients had type 1 diabetes. A total of 335 patients (67%) were treated with insulin, whereas 164 (32%) only received oral hypoglycemic medication. One patient had no recorded medical treatment
DISCUSSION
Our retrospective chart review of 500 diabetes patients from a commercial insurance FP and an MDC has 2 major findings: First, only a minority of patients, most of whom were insulin-treated, made r-SMBG data available to their providers. The other notable finding was that Medicare/ Medicaid patients with poorly controlled diabetes had a significant A1C reduction associated with r-SMBG, whereas this cannot be said for other subjects in this study. While many clinicians would not be surprised
CONCLUSION
Only a minority of patients, mostly treated with insulin, provided r-SMBG at the time of their office visits. A subgroup of patients with r-SMBG, those with Medicare/ Medicaid and uncontrolled diabetes (A1C > 8%) exhibited a mean between-visit decrease in A1C of 1.2% compared to those without r-SMBG, who experienced no decrease. While one could infer that this population greatly benefits from providing r-SMBG, prospective studies are needed to determine whether such patients are best served by
DISCLOSURE
Dr. Tamler has served as a consultant for Sanofi. Other authors have no multiplicity of interest to disclose.
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