Lack of proper information, motivational obstacles and behavioral skill limitations are the most influential factors that prevent people with diabetes from adhering to self-monitoring of blood glucose (SMBG) as recommended by their health care providers.

That is why a patient-focused approach in diabetes therapy is of pivotal importance to improve compliance and treatment outcomes. This was the overall consensus shared by leading experts in the field of diabetes care who attended the “Understanding the patients’ needs” media roundtable organized by Bayer HealthCare on the occasion of the 46th Annual Meeting of the European Association for the Study of Diabetes (EASD) in Stockholm, Sweden.

Among the speakers were Professor Oliver Schnell from the Diabetes Research Group at the Helmholtz Center in Munich/Germany, Professor Louis Monnier from the Laboratoire de Nutrition Humaine Institut Universitaire de Recherche Clinique in Montpellier/France, and diabetes nurse Magdalena Annersten Gershater from the Department of Endocrinology at University Hospital in Malmö/Sweden. They provided insights into common barriers to the self-monitoring of blood glucose and underlined why taking the personal situation and individual patients’ needs into account is a prerequisite for managing diabetes successfully.

Testing with a purpose making SMBG worthwhile

Performing SMBG for all types of diabetes treatment approaches is widely recommended for achieving proper glucose control and avoiding late complications. But only recently, individual patient conditions have been identified as additional factors which may influence adherence to SMBG and thus have to be taken into account by health care providers and educators. “Diabetes therapy needs to focus on the individual patient,” said Professor Schnell. The optimal intensity and frequency of SMBG protocols depend on a variety of factors such as the type of diabetes, chosen therapy options, individually set target ranges for the long-term marker HbA1c (also called A1c level) indicating the average blood glucose level over a period of weeks or months as well as pre- and postprandial results.

Said Professor Schnell, “International guidelines and standardized recommendations are helpful tools to further implement SMBG as an efficacious strategy, but need to be complemented by treatment approaches tailored to patients’ needs by addressing their specific educational, behavioral and clinical requirements.” In addition, innovative blood glucose meters offering meal-marker functions, integrated software and different levels of personalization support patients even further by ensuring simple, individualized diabetes management. They allow knowledge to be translated into concrete action such as the adjustment of meal planning, exercise, or insulin dosing.

Enhancing the understanding of barriers to SMBG

Health care providers are therefore eager to gain a better understanding of their patients’ needs and adapt their diabetes education accordingly. In his presentation, Professor Louis Monnier summarized the key findings of recent studies. Findings from this research show a significant relationship between existing information gaps, motivational deficits and limitations with regard to behavioral skills and the reported frequency of SMBG. “Patients often show only poor motivation to measure their values regularly if testing is not explained sufficiently, is perceived to be inconvenient or painful, or meters, strips or lancets are not reimbursed by the health care system,” stated Professor Monnier.

SMBG adherence can thus be improved by providing information about self-testing that is directly translatable into appropriate glycemic control based on blood sugar results, by stimulating the patient’s motivation to act on these insights, and training behavioral skills for acting effectively and changing lifestyle habits (e.g. nutrition, physical activity, frequency and timing of testing). “SMBG is an effective tool and essential for people with diabetes to obtain accurate blood sugar results,” said Professor Monnier. But reaping the full benefit from it takes knowledge, skills and willingness on the part of the patients to incorporate self-testing and therapy adjustments into the diabetes care plan.

Empowering diabetes patients to take back control by ongoing education

When it comes to motivating people with diabetes to test their blood glucose values, expert advice and psychological support provided by health care professionals both play a pivotal role. Apart from the diabetologist, the specialist diabetes nurse is the most important person for people with diabetes. Nurses in diabetes offer support and guidance for empowering patients to take over the decision-making role and control their disease in a self-determined way. They are in a key position to identify and overcome potential barriers keeping patients from adhering to SMBG. By offering psychological support, expert advice and guidance, they empower patients to take over the decision-making role and control their disease in a self-determined way.

“We help patients to understand and manage their condition successfully,” said Magdalena Annersten Gershater, who works as a diabetes nurse at Skane University Hospital in Malmö. By evaluating individual requirements such as the level of knowledge and education as well as analyzing problems perceived by the patients on a physical, psychological or social level, diabetes educators approach existing, underlying conditions and counteract them by offering proper information on blood glucose measurements or the effects of lifestyle changes. They are thus able to trigger changes in patient behavior and simplify the life of people with diabetes to a great extent by improving clinical outcomes.

As Magdalena Annersten Gershater summarized, diabetes education can help patients to better understand and accept lifestyle and therapeutic changes: “Providing regular feedback and support is essential to optimize glycemic control and maintain patient motivation and well-being. Ongoing education is important to empower patients and keep them engaged in effective long-term self-management.”

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Source: Bayer