This article is more than 5 years old. Information may no longer be current.
SMBG compliance common in gestational diabetes
Click Here to Manage Email Alerts
More than half of women with newly diagnosed gestational diabetes were compliant with self-monitoring blood glucose before and after meals, according to findings published in Diabetes Care.
Emmanuel Cosson, MD, PhD, of the department of endocrinology-diabetology-nutrition, Jean Verdier Hospital, Université Paris, and colleagues evaluated data from 91 women with newly diagnosed gestational diabetes who understood SMBG principles to determine the compliance with SMBG and reliability of diabetes logbooks. Data on participants were analyzed over 13 days.
Women attended an education program of pre- and postprandial glucose targets and how, when and why SMBG needs to be performed. They were considered compliant if glucose meter data showed that they performed at least 80% of both pre- and postprandial SMBG tests.
There researchers evaluated five categories of data:
- underreported data, defined as meter values not reported in the logbook;
- concordant data, defined as logbook values matching meter values;
- nonconcordant data, defined at values in the diary that were different from recorded data in the meter;
- overreported data, defined as values added in the diary without a corresponding value in the meter; and
- concordant empty data, defined as no meter measures and no self-reported value in the logbook.
Seventy-eight percent of women were compliant for preprandial SMBG tests and 65.9% were compliant for postprandial SMBG tests, for an overall compliance of 61.5%. A family history of diabetes was independently associated with compliance (OR = 0.38; 95% CI, 0.15-0.98).
There was a mean time of 141 minutes between pre- and postprandial glucose measurements, and 46.2% of women had 80% adequate timing (between 100 and 140 minutes). Ethnicity (P for trend = .003), higher HbA1c at the time of the educational program (P = .03), inadequate preprandial glucose control (P = .001), lower compliance for SMBG testing (P < .001), and lower concordance between logbook and glucose meter (P < .001) were associated with inadequate timing.
At least 90% of paired logbook-meter glucose values were performed by 81.3% of women, and 76.9% had at least 90% of paired logbook-meter glucose values after exclusion of concordant empty data. Compared with women with less than 90% concordant data, those with 90% concordant data were less likely to have a family history of type 2 diabetes in first-degree relatives (P < .01) and were more likely to be compliant (P < .0001) and have adequate postprandial timing (P < .01).
Preeclampsia was more likely to occur in women with poor compliance (12.1%) compared with those with good compliance (1.9%; P = .049). Compared with women with adequate postprandial SMBG timing, those with inadequate postprandial timing were more likely to be treated with insulin at the end of the educational program (P = .007) and overall during pregnancy (P = .01) and had higher HbA1c level at delivery (P = .002).
“The lack of meter-logbook agreement suggests that the real reason for monitoring was not understood by many patients, raising issues about motivation, perceived need, wishes to impress health care providers, denial of poor glucose control, and probably fear of insulin therapy,” the researchers wrote. “Finally, using the memory of blood glucose meters or automatically generated diary from glucose meters should improve the assessment of blood glucose control and guide clinical management and therefore might improve prognosis. In clinical practice, we suggest that the reliability of logbooks be checked by exploring glucometer memories as a matter of routine. For research purposes, our results claim for logbooks be abandoned and electronic data considered.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to Top
Pregnancy is usually considered a period of high attention. The findings of the study by Cosson and colleagues shows that this is not always true. Even in the presence of gestational diabetes, a condition capable of influencing a pregnancy’s course and outcomes, many women are not careful enough.
Self-monitoring of blood glucose is an easy action that provides important information on glucose status. Having scientific evidence that women with gestational diabetes have poor adherence and poor reliability to self-monitoring of blood glucose is a great piece of knowledge. The link of this noncompliance with the onset of poor pregnancy outcomes specifically in women with specific characteristics represents a relevant finding.
From a health care professional’s perspective, major efforts should be provided to empower women in self-care. The real reason for self-monitoring is probably not understood by many women. Greater engagement in understanding motivation, perceived need, wishes and fears (especially of insulin therapy) of these women should be taken. As immediate impact of this study on daily practice, caregivers should systematically check the glucose meter memory to improve gestational diabetes management.
Click Here to Manage Email Alerts