Evidence of patient self-testing at clinic review: Association with glycaemic control

Abstract

Aims: Home glucose testing and reflection on patterns are important elements of type 1 diabetes self-management. We hypothesised that patients who demonstrated evidence of self-testing by bringing a record book (capillary blood glucose monitoring diary) to clinic would have better glycaemic control than patients with a glucometer alone, or neither record book nor glucometer. Methods: This was a prospective observational study of 233 consecutive type 1 diabetes patients using basal-bolus insulin. Exclusion criteria were diagnosis of type 1 diabetes within the previous year, current pregnancy, or prior inclusion in this study. We recorded the presence or absence of a record book or glucometer at the clinic, glycated haemoglobin (HbA1c), and previous structured education attendance. Results: Of 233 patients, 90 brought a record book, 61 brought a glucometer and 82 brought neither. Mean HbA1c did not differ between patients with a record book (63 ± 2 mmol/mol [7.9 ± 0.2%]) or glucometer (63 ± 2 mmol/mol [7.9 ± 0.2%]), but was higher in those with neither (77 ± 2 mmol/mol [9.2±0.2%]; p<0.001). Patients bringing a record book were older on average than those with a glucometer or neither (49.6 ± 1.7 vs. 41.2 ± 1.7 vs. 40.6 ± 1.4 years; p<0.001) and had longer mean duration of diabetes (27.9 ± 2.0 vs. 19.2 ± 1.7 vs. 18.7 ± 1.6 years; p<0.001). Prior structured education did not predict the presence of a record book or glucometer in the clinic. Conclusions: Evidence of self-testing at clinic review, either as a record book or glucometer, was associated with improved control compared with those with neither. HbA1c did not differ between patients bringing a record book or glucometer. Self-reflection on glucose results is important for type 1 diabetes self-management, irrespective of the recording method used.