People with Type Diabetes Mellitus (T1DM) self-reported views on their own condition management reveal links to potentially improved outcomes and potential areas for service improvement

Stedman, M.; Rea, R.; Duff, C.J.; Livingston, M.; McLoughlin, K.; Wong, L.; Brown, S.; Grady, K.; Gadsby, R.; Paisley, A.; Fryer, A.A.; Heald, A.H.

Abstract

Background
The self-management of type 1 diabetes (T1DM) has moved forward in many areas over the last 40 years. Our study asked people with T1DM what is their experience of blood glucose (BG) monitoring day to day and how this influences decisions about insulin dosing.

Methods
An on-line self-reported questionnaire containing 44 questions prepared after consultation with clinicians and patients was circulated to people with T1DM 116 responders provided completed responses. Fixed responses were allocated specific values (e.g. not confident = 0 fairly confident = 1). Multivariate regression analysis was carried out. Only those 5 factors with p-value <0.05 were retained.

Results
59% of respondents were >50 years old and 66% had diabetes for >20 years, with 63% of patients reporting HbA1c results ≤8% or 64 mmol/mol.

Findings included; 75% used only 1 m; 56% had used the same meter for ≥3 years; 10% had tried flash monitors; 47% were concerned about current BG level; 85% were concerned about long-term impact of higher BG.

72% of respondents keep BG level high to avoid hypoglycaemia; 25% used ≥7 mmol/L as pre-meal BG target to calculate dose; 65% were concerned they might be over/under-dosing; 83% did not discuss accuracy when choosing meter. However 85% were confident in their meter’s performance.

The factors that linked to LOWER HbA1c included LESS units of basal insulin (p < 0.001), HIGHER number of daily BG tests (p = 0.008), LOWER bedtime blood glucose (p = 0.009), HIGHER patient’s concern over long-term impact of high BG (BG) (p < 0.009 but LOWER patient’s concern over current BG values (p = 0.009). The final statistical model could explain 41% of the observed variation in HbA1c.

Conclusion
Many people still run their BG high to avoid hypoglycaemia. Concern about the longer-term consequences of suboptimal glycaemic control was associated with a lower HbA1c and is an area to explore in the future when considering how to help people with T1DM.

Citation

Stedman, M., Rea, R., Duff, C., Livingston, M., McLoughlin, K., Wong, L., …Heald, A. (2020). People with Type Diabetes Mellitus (T1DM) self-reported views on their own condition management reveal links to potentially improved outcomes and potential areas for service improvement. Diabetes Research and Clinical Practice, 170, Article 108479. https://doi.org/10.1016/j.diabres.2020.108479

• Journal Article Type: Article
• Acceptance Date: Sep 21, 2020
• Online Publication Date: Sep 28, 2020
• Publication Date: Sep 28, 2020
• Deposit Date: Jun 19, 2023
• Journal: Diabetes research and clinical practice
• Print ISSN: 0168-8227
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 170
• Article Number: 108479
• DOI: https://doi.org/10.1016/j.diabres.2020.108479
• Keywords: Endocrinology; General Medicine; Endocrinology, Diabetes and Metabolism; Internal Medicine
• PMID: 33002551
• Additional Information: This article is maintained by: Elsevier; Article Title: People with Type Diabetes Mellitus (T1DM) self-reported views on their own condition management reveal links to potentially improved outcomes and potential areas for service improvement; Journal Title: Diabetes Research and Clinical Practice; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.diabres.2020.108479; Content Type: article; Copyright: © 2020 Elsevier B.V. All rights reserved.