Implementation of a Self-Monitoring Blood Glucose Log to Improve Adherence in Patients with Type 2 Diabetes Mellitus in the Outpatient Setting

Abstract

Type II Diabetes Mellitus (T2DM) is the most prevalent type of diabetes, occurring in approximately 90% to 95% of people with diabetes. Adherence to diabetes self‐care skills improves patients’ health outcomes and quality of life. However, studies show that for adult patients with T2DM, the adherence to self-monitoring blood sugar (SMBG) is as low as 24 percent. A SMBG tracking system allows patients and providers to identify blood glucose (BG) patterns and alter treatment regimens or lifestyle factors accordingly. The purpose of this quality improvement project was to develop a patient-driven SMBG recording system for patients with T2DM with the goal to improve SMBG adherence. Patients with T2DM were provided with a log form to keep track and record their blood glucose (BG) over a period of 3 months. Patients were encouraged to turn in their BG logs periodically via standardized bi-weekly reminder emails and a reminder phone call. Increased overall patient adherence to SMBG was calculated and documented by log return and overall log completion for all logs received. Out of twenty-five (25) patients, four (4) emailed at least one log with their BG measurements in 3 months, accounting for 16% of the patients when the original goal for log return was 25%. For log completion on all logs received, a total average of 21.2 days, or 70% of days per month, with at least one BG measurement was calculated, surpassing the original log completion goal of 7.5 days or 25% of days per month. For those patients who did engage, using a BG tracking log increased SMBG adherence. Suggestions for the future include more controlled studies with larger sample size and longer implementation period, multiple cohorts, and analysis of patients’ change in HbA1c to assess clinical relevance.