CHICAGO -- Most patients with type 1 diabetes aren't checking blood glucose data from their devices, researchers reported here.
In an online survey, almost 70% of patients said they hadn't downloaded the data from their devices to their computers at all over the past year, Jenise Wong, MD, PhD, of the University of California San Francisco, and colleagues reported at an oral session at the joint meeting of the Endocrine Society and the International Congress on Endocrinology here.
'We need to really equip patients with better tools and education on how to use their data,' Wong said during a press briefing, comparing the retrospective functionality of diabetes devices to analyzing a credit card statement.
'You use the credit card to make purchases in real time every day, but ... you review your credit card statement to get a better idea of what you're spending on and how to plan for the future,' she said, noting the similarities when planning for insulin doses and better glucose control.
Patients with type 1 diabetes use a range of devices, from finger-stick blood glucose meters to insulin pumps and continuous glucose monitors (CGM). Data from these devices can be uploaded to a computer and reviewed by both the patient and the physician -- although this is typically being done by the latter.
To get a better sense of how often patients are checking out their data, Wong and colleagues surveyed 155 patients who had a median age of 29.5, a median diabetes duration of 18.5 years, and a mean HbA1c of 8%.
Almost all of the patients (97%) said they used finger-stick glucose meters, 68% used insulin pumps, and 28% used CGM.
But they found that very few patients downloaded and reviewed their data. Only 31% downloaded data at least once in the past year, which means that 'about 70% of patients didn't download any data, not even once over the past year.'
Only 20% were frequent down-loaders, meaning they put the information from their devices onto their computers at least four times per year. Still, only 12% were frequent reviewers who actually tried to make sense of that data after downloading it, Wong said.
When broken down by device, patients seemed to be much better about looking at CGM data. Almost half of these patients downloaded their information at least once in the past year, with 40% being frequent down-loaders and 28% being frequent reviewers.
'It could be that CGM data and the way they're presented are more useful to patients,' Wong said.
For insulin pumps, 16% of patients were frequent down-loaders and 7% were frequent reviewers, while 12% frequently downloaded their finger-stick glucose meter data and 5% frequently reviewed it.
Patients said barriers to uploading and reviewing the information included the fact that the doctor didn't ask them to do so, they didn't know how to do so, they didn't have the software, or they had trouble downloading the information, Wong said.
In further analyses, they found that frequent reviewers were older (OR 1.5, 95% CI 1.1 to 2.1, P=0.02) and had diabetes for a longer period of time (OR 1.7, 95% CI 1.2 to 2.4, P=0.01).
There were no associations between likelihood of data review and gender, ethnicity, type of insurance, or education level.
Initially, there was an association between better control and frequency of data review (8.1% for infrequent versus 7.2% for frequent reviewers, P=0.03) but it disappeared in analyses that were adjusted for the previous factors.
It could be that the survey's small sample size left it underpowered to detect such a different, and Wong said further prospective studies might show a relationship.
Wong concluded that the major barriers to wider reviewing of device data are a lack of guidance and motivation, as well as a lack of good tools that make the data usable and actionable.
'We may need to improve device hardware or transfer data to devices patients actually use, like smartphones,' Wong said during her presentation. 'Also, the software could be more user-friendly, and it could give patients a better grasp of what their numbers really mean.'
Physicians also need to help patients better recognize patterns and understand their information.
'I think just asking patients to download their data and review it, which as it stands now is often just a list of numbers an complex graphs isn't going to be enough to change outcomes,' Wong said. 'We need better tools to teach patients how to use that data and work toward self-management.'
Siri Atma W. Greeley, MD, PhD, of the University of Chicago, who moderated the session during which the findings were presented, agreed that 'if we can give patients tools to make understanding their data easier, that would be a very good thing.'
Wong reported no relevant conflicts of interest.
Primary source: Endocrine Society meeting Source reference: Wong JC, et al 'Few adults with type 1 diabetes (T1D) download and retrospectively review their diabetes device data' ICE/ENDO 2014; Abstract OR26-5.
