TY - JOUR
T1 - Real-world use of self-monitoring of blood glucose in people with type 2 diabetes
T2 - an urgent need for improvement
AU - the AMD Annals-SMBG Study Group
AU - Rossi, Maria Chiara
AU - Lucisano, Giuseppe
AU - Ceriello, Antonio
AU - Mazzucchelli, Chiara
AU - Musacchio, Nicoletta
AU - Ozzello, Alessandro
AU - Nicolucci, Antonio
AU - Di Bartolo, Paolo
AU - Annamaria, Nuzzi
AU - Mario, Velussi
AU - Francesca, Spanu
AU - Andrea, Del Buono
AU - Graziano, Santantonio
AU - Giampaolo, Magro
AU - Gabriella, Garrapa
AU - Daniela, Antenucci
AU - Mario, Laudato
AU - Giovanni, Saitta
AU - Mauro, Stroppiana
AU - Francesco, D’Agati A.
AU - Roberto, Anichini
AU - Paolo, Di Bartolo
AU - Emilio, Rastelli
AU - Sergio, Leotta
AU - Giuseppe, Felace
AU - Carlo, Lalli
AU - Laura, Tonutti
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Aims: To assess use of self-monitoring of blood glucose (SMBG) in type 2 diabetes (T2DM) in the context of a continuous quality improvement initiative (AMD Annals). Methods: 14 quality-of-care indicators were developed, including frequency of SMBG, fasting blood glucose (FBG), and post-prandial glucose (PPG) levels, and hypoglycemia and hyperglycemia episodes. Clinical data and SMBG values downloaded from any glucose meter were obtained from electronic medical records. The most frequently used glucose-lowering treatment regimens were identified and the indicators were assessed separately by regimen. Results: Overall, 21 Italian centers and 13,331 patients (accounting for 35,657 HbA1c tests and 8.44 million SMBG values collected during 2014 and 2015) were included in the analysis; 11 therapeutic regimens were selected. Patients in regimens not including insulin performed 15–23 measurements per patient-month, those treated with basal insulin 32.1 tests/patient-month, and those treated with basal and short-acting insulin 53–58 tests/patient-month. In all treatment regimens, PPG measurements represented a minority of all tests; pre-breakfast measurements accounted for about 50% of all FBG values. Mean FBG levels exceeded 130 mg/dl in 49.3–88.3% of the cases in the different treatment regimens, while PPG levels were over 140 mg/dl in 46.7–81.0%. From 5.7 to 32.7%, patients in the different regimens had at least one episode of hypoglycemia (< 70 mg/dl), while from 3.7 to 47.7% had at least one episode of hyperglycemia (> 300 mg/dl). Conclusions: SMBG is underutilized in patients with T2DM treated or not with insulin. In all treatment groups, PPG is seldom investigated. Poor metabolic control and rates of hyper- and hypoglycemia deserve consideration in all treatment groups.
AB - Aims: To assess use of self-monitoring of blood glucose (SMBG) in type 2 diabetes (T2DM) in the context of a continuous quality improvement initiative (AMD Annals). Methods: 14 quality-of-care indicators were developed, including frequency of SMBG, fasting blood glucose (FBG), and post-prandial glucose (PPG) levels, and hypoglycemia and hyperglycemia episodes. Clinical data and SMBG values downloaded from any glucose meter were obtained from electronic medical records. The most frequently used glucose-lowering treatment regimens were identified and the indicators were assessed separately by regimen. Results: Overall, 21 Italian centers and 13,331 patients (accounting for 35,657 HbA1c tests and 8.44 million SMBG values collected during 2014 and 2015) were included in the analysis; 11 therapeutic regimens were selected. Patients in regimens not including insulin performed 15–23 measurements per patient-month, those treated with basal insulin 32.1 tests/patient-month, and those treated with basal and short-acting insulin 53–58 tests/patient-month. In all treatment regimens, PPG measurements represented a minority of all tests; pre-breakfast measurements accounted for about 50% of all FBG values. Mean FBG levels exceeded 130 mg/dl in 49.3–88.3% of the cases in the different treatment regimens, while PPG levels were over 140 mg/dl in 46.7–81.0%. From 5.7 to 32.7%, patients in the different regimens had at least one episode of hypoglycemia (< 70 mg/dl), while from 3.7 to 47.7% had at least one episode of hyperglycemia (> 300 mg/dl). Conclusions: SMBG is underutilized in patients with T2DM treated or not with insulin. In all treatment groups, PPG is seldom investigated. Poor metabolic control and rates of hyper- and hypoglycemia deserve consideration in all treatment groups.
KW - Adherence
KW - Benchmarking
KW - Quality of care
KW - Self-monitoring blood glucose
KW - Type 2 diabetes
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U2 - 10.1007/s00592-018-1186-z
DO - 10.1007/s00592-018-1186-z
M3 - Article
C2 - 30062588
AN - SCOPUS:85050984891
VL - 55
SP - 1059
EP - 1066
JO - Acta Diabetologica
JF - Acta Diabetologica
SN - 0940-5429
IS - 10
ER -