Empowering Patients with T2DM through Meaningful Monitoring
By Laura Del Guerra, RD, CDE
How many times have your patients expressed frustration with health care providers who ask for blood glucose monitoring results, but then don’t look at them? As a health care provider, how often are you frustrated when a person with T2DM comes for an appointment and hands over their blood glucose monitor so you can review the readings? Both scenarios are all too familiar to me, and lead to frustration for both myself and the person with diabetes.
In 2016, the American Association of Clinical Endocrinologists published a consensus statement on the outpatient monitoring of blood glucose. The statement offered not only structure and guidance on when and how blood glucose monitoring should be done, but also coined the phrase, “meaningful monitoring.” It is a phrase CDE’s have been using for years, but it seems that now the time has come to use our advocacy skills to further empower patients.
Controversy still exists on the benefit of blood glucose monitoring in people with T2DM who are not on insulin or other medications. However, more and more studies are showing the benefits of structured testing in lowering A1c levels in these people. In the quickly evolving world of diabetes self-care management, blood glucose data is now referred to as patient-generated health care data.
Many people with T2DM routinely check their blood glucose levels as directed by their health care providers. The patient usually glances at each result before it is committed to the memory of the monitor, and gives little thought about it until the next provider visit. Further, the data collected can seem overwhelming and meaningless, which does not foster empowerment.
Structured testing can help people who do not use insulin to understand the effect of physical activity and food choice on blood glucose. The first step in empowering patients is to have them take ownership of their blood glucose data.
As CDE’s, we understand the value of blood glucose monitoring, and we need to continually reinforce this with our patients. The data collected needs to be in an actionable format, not read back result by result from the monitor. Spend time at each visit discussing blood glucose results. Draw correlations, and help patients understand the impact that diet, exercise, illness, stress and medication have on blood glucose. Ask if there any current issues with high or low blood glucose values. Overnight, after meals, after eating certain foods? As you review the results with your patient, compare them with the patient’s blood glucose goals or developed standards. Work as a team, but let the patient lead the discussion, pointing out trends in the data, areas of concern or where improvements could be made. Guide and assist in problem-solving with the patient, and offer assistance as needed. To effectively empower the patient, we need to move from the driver’s seat to the passenger seat. Instead of driving patient care, we need to be in the passenger seat navigating. Finally, develop an action plan and implement it in conjunction with the health care team. Timely follow-up, re-evaluation, and adjustments in therapy will need to be made to continue moving toward the patient goal.
CDE’s are an invaluable resource and wealth of knowledge in the world of diabetes management. Nothing provides me a greater sense of accomplishment than when a patient spots an issue and offers a solution. I know that I have done my job as an educator who empowers patients to self-manage.