Improving Glucose Self-Management Practices Among Adults with Type 2 Diabetes

Type 2 diabetes mellitus (T2DM) has become an enormous health burden affecting all age groups, all ethnicities, and all regions of the world. One in three Americans is at risk for T2DM. The burden of the disease is emotionally, physically, and financially devastating. The risk of complications of T2DM can be significantly reduced if individuals maintain optimal glycemic control with a hemoglobin A1c (HbA1c) less than 7%. One way individuals track blood glucose on a daily basis is by self-monitoring blood glucose (SMBG) levels with a personal glucometer. When individuals with T2DM employ SMBG, they are able to make dietary, lifestyle, and pharmacological adjustments to help achieve optimal glycemic control. Individuals with T2DM have a low frequency of SMBG testing. The aim of this project was to implement an intervention to assist adults with T2DM in achieving optimal glucose control by engaging in personalized glucose monitoring. Problem solving is a behavioral intervention that has been shown to be effective in increasing self-management behaviors, including SMBG. Objectives of the project included: (1) Identify 10-15 patients in primary care setting with a HbA1c greater than 7.0%; (2) Implement a patient-centered, evidence-based intervention using problem solving to improve frequency of SMBG within this population at encounters for T2DM care; (3) Three months after implementation of program in designated population, measure changes in frequency of SMBG and HbA1c; and (4) Disseminate findings of the project to a larger audience. After obtaining Institutional Review Board approval for the project, participants were recruited to participate in the problem solving intervention feasibility study. A total of n=9 participants were recruited, but one was lost to follow up and one was excluded based on her self-reported frequency of SMBG. HbA1c and self-reported frequency of SMBG were measured and a problem solving session took place during the participant's regular T2DM visit. After 3 months, the HbA1c and self-reported frequency of SMBG were again measured and compared to the pre-intervention data. Participants in the feasibility study were majority Caucasian, 6 (86%) and female 4 (57%). The mean age was 59 ±10 years. The average self-reported frequency of SMBG before the intervention was 5 ±5.6 times per week, and after the intervention was 8 ±5.1 times per week (p=0.82). The average HbA1c among participants before the intervention was 8.51% ±1.2, and after the intervention was 8.4% ±1.15 (p=0.62). Neither change in frequency of SMBG or HbA1c was statistically significant, likely due to the fact that this feasibility study was underpowered to detect these outcomes. After all data was collected, project findings were summarized and disseminated with an oral presentation to the clinic in which the intervention project was conducted as well as submitting an abstract to a local professional conference. In summary, the purpose of this project was to implement a previously tested, successful problem-solving intervention in a primary care practice to determine if patients could successfully increase the frequency of SMBG and achieve a decrease in HbA1c. The problem solving intervention was successfully implemented, but is not sustainable due to the lack of provider time to complete the intervention. There was an overall increase in frequency of SMBG and decrease in HbA1c, but the change was not significant. If the intervention were to be continued, providers should elicit help from a certified diabetes educator