Self-Management of Diabetes Mellitus with Remote Monitoring: A Retrospective Review of 214 Cases

Self-Management of Diabetes Mellitus with Remote Monitoring: A Retrospective Review of 214 Cases

Hayat Mushcab, William George Kernohan, Jonathan Wallace, Roy Harper, Suzanne Martin
Copyright: © 2017 |Pages: 10
DOI: 10.4018/IJEHMC.2017010104
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Purpose: The efficacy of one remote monitoring system was reviewed in order to explore if optimal self-management of diabetes was achieved. Methods: Medical records of 214 patients with diabetes were reviewed from seven diabetes clinics within a single Health & Social Care trust using a remote monitoring solution to help patients self-manage their condition. Data on HbA1c, blood glucose, blood pressure and body mass index were obtained from the patient's medical record, before and after using the remote monitoring solution. Results: The average age of users was 61 years: 60% of the sample were male. The average time living with diabetes was 14 years; the mean duration with remote telemonitoring was 147 days. A greater reduction in HbA1c was seen with female users compared to males 2.37% and 0.87%, respectively. Conclusion: Remote telemonitoring provided the opportunity to collect comprehensive data, allowing patients to be maintained at home, while showing significant improvement in their HbA1c and better overall management of their diabetes
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Globally, diabetes mellitus is considered to be an epidemic and a growing burden on public health (Matuleviciene, et al., 2014). It is associated with a significant morbidity and mortality (Schwartz & Scheiner, 2012). It has been estimated that 385 million people worldwide live with Diabetes and the number is predicted to rise to 500 million in 2030 (Matuleviciene, et al., 2014). In the UK, there are some four million people diagnosed with diabetes and an estimated additional 590,000 that are not yet diagnosed (Diabetes UK, 2015). The costs associated with diabetes account for almost 10% of the NHS primary care budget with a daily average expenditure of £2.2m on prescriptions for managing the condition (Matuleviciene, et al., 2014) (Lacobucci, 2014).

The key to good self-management of diabetes is to understand the importance of regular blood glucose measurement and the need for good blood glucose control together with a strong belief in one’s ability to achieve target levels. Levels of blood glucose vary dynamically from one individual to another and a recommended target range for blood glucose is determined by the healthcare team (, Blood Sugar Level Ranges). The target is individualised and based on the duration of diabetes, age, comorbid conditions, micro/ macrovascular diseases, hypo/ hyperglycaemia awareness and other individual considerations such as patient’s lifestyle and dietary habits (ADA, Checking Your Blood Glucose, 2015).

The American Diabetes Association suggests the blood glucose target in those with diabetes should be 4.4 to 7.2 mmol/L (80 to 130 mg/dL) before meals and under 9.0 mmol/L (162 mg/dL) for people with type 1 diabetes (T1DM) and under 8.5 mmol/L (153 mg/dL) for people with type 2 diabetes (T2DM) after meals (, Blood Sugar Level Ranges) (ADA, Checking Your Blood Glucose, 2015). These equate to glycated haemoglobin (HbA1c) levels of less than 7% or 48 mmol/L for people with diabetes (ADA, Checking Your Blood Glucose, 2015) (, Guide to HbA1c). The healthcare team can get an overall idea of the average blood glucose levels over a period of time –usually every three months- by regular measurement of HbA1c (Matuleviciene, et al., 2014) (, Guide to HbA1c). HbA1c is the gold standard marker for assessing long-term glycaemic control; however, it does not reveal the immediate hour-to-hour blood glucose levels like self-monitoring of blood glucose does and it does not provide detailed information about individual hyperglycaemic or hypoglycaemic excursions (Boutati & Raptis, 2009).

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