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

Abstract

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.

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).

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.

Trial registration: Trial registration number: NCT02925312 (10/19/2016).

Keywords: Blood glucose meter; Diabetes care management; Remote glucose monitoring; Self-monitoring of blood glucose.

Conflict of interest statement

Ms. Kelly Gann is a full-time employee at Biotelemetry, the maker of the blood glucose management system used in the study. Drs. Montero, Toro-Tobón and Magee, and Ms. Nassar and Ms. Youssef report no conflicts of interest relevant to this research.

© 2021. The Author(s).

Figures

Fig. 1

Visual representation of the Diabetes Boot Camp (DBC) workflow. All finger-stick blood values were automatically uploaded to a cloud-based dashboard via cellular networks in near, real-time. The DBC’s team accessed the cloud-based dashboard and conducted a weekly audit of glycemic trends and a daily audit of FSBG extremes. The participant was contacted by the DBC’s team to provide medication titration, guidance, and further education when teachable moments (Including, FSBG extremes) were identified. (Figure was designed and owned by the authors of this manuscript)