Interpretation of Blood Sugar Levels with Self-monitoring Blood Glucose

Regular checking of blood sugar levels with structured self-monitoring of blood glucose (SMBG) regimens can help improve the health and quality of life in diabetic patients. However, it can be hard to interpret the blood glucose (bG) results correctly, so proper actions could be taken if needed. Many do not understand how their medications and lifestyle choices affect their bG levels, making it challenging to achieve glycemic control without consulting the doctor.

Accu-Chek® Instant Blood Glucose Meter for Easier Blood Glucose Interpretation

To assist SMBG users in understanding their glucose test results, many manufacturers are now including interpretation tools in their SMBG meters. Accu-Chek® Instant blood glucose meter is a new generation bG monitoring system with a target range indicator [TRI] to assist users in interpreting their bG results. Unlike other systems, Accu-Chek® uses a TRI with a 9-point scale to help people with diabetes understand their glycemic risk. Although there is reason to think that SMBG systems with data interpretation tools can help people understand the results, there have not been many studies supporting it.

This study compared the TRI support tool with two other on-meter support tools - “Colors” and “Smiley” icons to see which data interpretation support tool could help participants with diabetes better understand their bG results.

The Study on the Target Indicator Tool for a Better Understanding of Blood Glucose Levels

This study was designed to create a cohort representing the general diabetes population. In this sample used, 17 have type 1 diabetes (T1D), and 123 with type 2 diabetes (T2D). Participants assessed 50 bG values in millimoles per liter (mmol/L)without using any tool and repeated the assessment using one of the three tool configurations — “TRI”, “Colors”, or “Smiley” icons. The investigators also assessed user preferences and perceptions regarding the usefulness and percentage changes of correct responses when using a support tool.

These sessions, which the investigators conducted individually, have three parts. In Part 1, they categorized the 50 bG levels, presented randomly, into 1 of 7 categories on a scale, without any support tool. The categories were “extremely high” (18.8-22.2 mmol/l); “very high” (13.4-18.8 mmol/l); “high” (8.9-13.3 mmol/l); “in range” (3.9-8.9 mmol/l); “low” 2.8-3.8 mmol/l); “very low” (1.7-2.7 mmol/l); and “extremely low” (0.6-1.6 mmol/l). These values were based on the International Diabetes Federation (IDF) guidelines for high values and American Diabetes Association (ADA) guidelines for low values. Immediately after categorizing the 15th, 30th, and 50th bG values, participants were asked to assess how confident they were in categorizing the bG values. They used a four-point confidence scale: 1 = “not confident at all”; 2 = “somewhat confident”; 3 = “confident”; and 4 = “very confident.”

In Part 2, the participants were randomly assigned to use one of the three different support tool configurations. 47 used TRI, 46 had Colors, and 47 used Smiley. The same bG values were again shown in random order, and participants’ confidence was assessed after the 15th, 30th, and 50th values. Participants then answered a questionnaire regarding their perceptions of the usefulness, clinical utility, and benefits of the support tool they evaluated using a 5-point Likert-type scale: 1 for “disagree”; 2 for “somewhat disagree”; 3 for “neither agree nor disagree”; 4 for “somewhat agree”; 5 for “agree.”

For Part 3, the participants ranked according to personal preference, seven real-size laminated pictures of bG meter displays which the investigators presented in random order. Each display has three versions — low, in range, and high bG values.

The Results

The signficant increase in correct responses was seen in all study groups but most notably in the TRI group (26%) versus the Colors (3%) and Smiley icons (6%) groups. Remarkably, among the T2D cohort, 20 participants (48%) in the TRI group scored more than 90% correct responses, whereas nobody scored that much in the other groups.

Significant improvements in confidence were seen among TRI users but not among other tool users. Most TRI users felt confident (94%) in categorizing the bG values. They agreed the tool was intuitive (89%) and would help them identify high and low values (96%).

The majority of all participants reported that the support tool configurations they evaluated would help them correctly, easily, and quickly interpret their bG values.

When assessing the clinical utility of their support tool, a larger percentage (94%) of participants reported that the TRI tool would facilitate communications with their health care professional and would help them make correct insulin dosage decisions (80%).

Most participants (88%) agreed that they would benefit from using a support tool. A higher percentage (94%) of participants preferred the TRI configuration and reported they would switch to a meter that offers this support tool (87%). Regarding support tool design, almost all participants preferred a support tool that differentiates various levels of high (90%) and low (89%) bG levels. Only the TRI support tool has this differentiation to offer. This capacity to differentiate between various levels of high and low bG is critical to appropriate decision-making.

In Part 3, the display of the Accu-Chek Instant system was rated as the most preferred one.

The Conclusion

Use of the Target Range Indicator significantly increases users’ ability to correctly and confidently determine their glycemic risk when monitoring their bG levels by themselves. This finding suggests that the tool may offer greater clinical value to individuals with Type 1 Diabetes and Type 2 Diabetes.

Reference

Use of an Integrated Tool for Interpretation of Blood Glucose Data Improves Correctness of Glycemic Risk Assessment in Individuals with Type 1 and Type 2 Diabetes