Availability of Reliable Home Blood Glucose Data at Diabetes Appointments and Correlation with Hemoglobin A1C

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 807-838-Diabetes - Diagnosis, Complications & Outcomes
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-812
Gillian Boyd-Woschinko*, David Kaiser, Michael Diefenbach and Ronald Tamler
Icahn School of Medicine at Mount Sinai, New York, NY
Background: Patients with diabetes are encouraged to perform self-monitoring of blood glucose (SMBG) and to bring glucose logs or meters with stored data to appointments. It is poorly understood how many patients follow through with sharing reliable SMBG (r-SMBG) data with their providers in the clinical setting and whether doing so preferentially benefits certain patient populations.

Study: We conducted a chart review of 500 established patients followed in an Endocrinology Faculty/Commercial Insurance Practice (FP) or a Managed Medicare/Medicaid Diabetes Clinic (MDC). Follow-up  visits for type 1 or type 2 diabetes from January 1st 2012 to June 30th2012 were abstracted for anthropometric data, hemoglobin A1C (A1C), change in A1C from the previous visit (delta A1C), and, based on the progress note, availability of r-SMBG data at time of visit.  Our sample was composed of 215 MDC patients (43%) and 285 FP patients (57%). 297 patients (59.4%) were female, 181 (36%) were Hispanic, 152 (30%) were African American, and 106 (21%) were Caucasian. 10% had type 1 diabetes. 335 patients (67%) were treated with insulin, whereas 164 (32%) received solely oral hypoglycemic medication. Overall, 151 patients (30%) provided r-SMBG data at their visit, with no difference between MDC or FP patients. All MDC patients with r-SMBG were using insulin, and only 8 FP patients with r-SMBG were treated exclusively with oral medication. Mean A1C at MDC was 9.2%, while mean A1C at FP was 8.0% (p<0.001). MDC patients with A1C >8.0% demonstrated a delta A1C of -1.2% if they provided r-SMBG, compared to +0.1% delta A1C for MDC patients who did not (p=0.05). Providing r-SMBG did not affect delta A1C in FP patients in any A1C range.

Conclusions:  Only a minority of diabetes patients, almost exclusively insulin-treated, made r-SMBG data available to their providers during the visit, despite advancing glucose meter technology and reminders.  Furthermore, insulin-requiring Managed Medicare/Medicaid patients with poorly controlled diabetes derived benefit from having r-SMBG. This result was not seen in commercially insured patients. Our findings may help focus resources by defining the patient population most likely to benefit from receiving reminders to bring reliable SMBG data from home to appointments. Whether bringing r-SMBG to the visit is the cause of improved diabetes control or a marker of improved compliance warrants further investigation.

Nothing to Disclose: GB, DK, MD, RT

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm