Better evidence needed on the effectiveness of tailored interventions on self management type 2 diabetes

Better evidence needed on the effectiveness of tailored interventions on self management type 2 diabetes

The value of self-control self-Control in diabetes mellitus is called independent determination of the patient’s blood sugar content (or urine). This term is sometimes used in a broader sense, as the ability to assess your condition, properly conduct medical measures, for example, follow a diet or change the dose of sugar-lowering medications. Since the main goal in the treatment of diabetes is to constantly maintain normal blood sugar levels, there is a need for frequent definitions of it. It was said above that the patient should not rely on his own subjective feelings. Traditional blood sugar control: only on an empty stomach and, as a rule, no more than once a month, can not be considered sufficient. Fortunately, in recent years, many high-quality means of rapid determination of blood or urine sugar (test strips and glucose meters) have been created. An increasing number of diabetic patients around the world, including in our country, conduct frequent self-monitoring of blood sugar on a permanent basis.

It is in the process of such self-control that the correct understanding of your disease comes, and skills for managing diabetes are developed. Unfortunately, the availability of means of self-control in our country is still far from sufficient. Constant use of test strips requires financial expenses on the part of the patient. It is difficult to recommend anything here, except for one thing: try to allocate your available funds wisely! It is better to buy test strips for self-control than to spend money on questionable methods of” curing “diabetes or not so necessary, but expensive “diabetic” products. Types of self-control so, the patient can independently determine blood sugar or urine sugar. Urine sugar is determined by test strips without the help of devices, comparing the staining of the urine-soaked strip with the color scale available on the package. The more intense the staining, the higher the sugar content in the urine.

Visual test strips for determining blood sugar there are two types of tools for determining blood sugar: so-called “visual” test strips that work in the same way as urine strips (comparing color with a color scale), as well as compact devices – glucose meters that give the result of measuring sugar levels in the form of a number on the display screen. The blood glucose meter also works using test strips, and each device corresponds only to its” own ” strip.

Therefore, when purchasing a device, first of all, you need to take care of the possibilities of further purchasing suitable test strips. Some patients make the mistake of bringing a blood glucose meter from abroad or making such a request to friends. As a result, they may get a device that they can’t get the strips to. At the same time, the domestic market now has a very large selection of high-quality and reliable devices (see Fig. 5). When choosing a means of self-control, every diabetic should decide what is best for them. sahdib2tip6.jpg figure 5. blood glucose Meters – self-monitoring blood sugar Test strips for determining sugar in the urine are cheaper and easier to use. However, if we remember what goals should be achieved in diabetes with respect to blood sugar, it will be clear why self-monitoring by urine is less valuable. Indeed, since it is necessary to strive for normal blood sugar indicators, and in the urine sugar appears only when its level in the blood is more than 10 mmol/l, the patient can not be calm, even if the results of measurements of sugar in the urine are always negative.

After all, blood sugar can also be in undesirable limits: 8-10 mmol/l. Another disadvantage of self-monitoring of urine sugar is the inability to determine hypoglycemia. A negative result for the sugar content in the urine can correspond to both normal or moderately elevated, and low blood sugar levels. Finally, the situation of deviation of the level of the renal threshold from the average norm can create additional problems. For example, it may be 12 mmol / l, and then the meaning of self-monitoring for urine sugar is completely lost. By the way, it is not very easy to determine an individual kidney threshold. For this purpose, repeated comparison of paired definitions of sugar in the blood and in the urine is used. In this case, the urine sugar should be measured in a “fresh portion”, i.e. collected within half an hour after the preliminary complete emptying of the bladder. The blood sugar level should be determined in the same time period. Even when there are many such pairs – blood sugar / urine sugar – it is not always possible to accurately determine the renal sugar threshold. Summing up, we can conclude that self-monitoring of the sugar content in the urine is not informative enough to fully assess the compensation of diabetes, but if self-monitoring of blood sugar levels is not available, it is still better than nothing! Self-monitoring of blood sugar costs the patient more, it requires more complex manipulations (you need to pierce your finger to get blood, conveniently place the device, etc.), but its informative content is exhaustive.

Devices-glucose meters and test strips to them are more expensive than visual test strips, although, according to some data, the latter are not inferior to the first in accuracy of determination. In the end, the choice of self-monitoring tools is left to the patient, taking into account financial opportunities, confidence in the correctness of determining the color of the visual test strip when compared with the scale, etc. Currently, the choice of self-monitoring tools is very large; new devices are constantly appearing, and old models are being improved. As medical experience shows, it is not uncommon for patients who have the best means of self-control, and in sufficient numbers, to conduct self-control is not quite productive. Example 1: blood sugar level is Determined once every two weeks-a month and only on an empty stomach (based on the sample taken in the clinic). Even if the indicators fall within satisfactory limits, such self-control can not be called sufficient: the definitions are too rare, and information about blood sugar levels during the day completely falls out! Example 2: Frequent monitoring, several times a day, including after meals. At the same time, the results for a long time are constantly unsatisfactory-above 9 mmol/l. Such self-control, despite its high frequency, is also not productive.

The point of self-monitoring is not only to periodically check blood sugar levels, but also to correctly evaluate the results and plan certain actions if the goals for sugar indicators are not met. We have already mentioned the need for each patient with diabetes to have extensive knowledge of their disease. A competent patient can always analyze the reasons for the deterioration of sugar indicators: perhaps this was preceded by serious errors in nutrition and, as a result, weight gain? Maybe there is a cold, increased body temperature? However, not only knowledge is important, but also skills. Being able to make the right decision in any situation and start acting correctly is not only the result of a high level of knowledge about diabetes, but also the ability to manage your disease, while achieving good results. To return to proper nutrition, get rid of excess weight, and achieve improved self-control indicators means to truly control diabetes. In some cases, the correct solution is to immediately consult a doctor and refuse to make independent attempts to cope with the situation. Having discussed the main goal, we can now formulate separate tasks of self-control: 1. Assessment of the effects of nutrition and physical activity on blood sugar indicators. 2. Checking the status of diabetes compensation. 3. Managing new situations during the course of the disease. 4. Change, if necessary, the doses of insulin (for patients on insulin therapy). 5. Identification of hypoglycemia with possible changes in drug treatment for their prevention. Self-monitoring mode How often and at what time should blood sugar (urine) be determined? Do I need to record the results? The self-monitoring program is always individual and should take into account the capabilities and lifestyle of each patient. However, a number of General recommendations can be given to all patients. It is always better to record the results of self-monitoring (with the date and time, as well as any notes at Your discretion). Even if you use a blood glucose meter with memory, it is more convenient to use more detailed records for your own analysis and for discussion with your doctor. Self-monitoring mode should approach the following pattern: determination of the sugar content in the urine after eating 1-7 times a week, if the results are constantly negative (there is no sugar in the urine). if you define sugar in blood, the frequency must be the same, but to define should as before meals and 1-2 hours after a meal; if the unsatisfactory compensation of diabetes, determine the blood sugar speeds up to 1-4 times a day (at the same time the situation is analyzed and, if necessary, consultation with a doctor). the same self-monitoring regime is necessary even with satisfactory sugar indicators, if the patient receives insulin; determining the blood sugar content 4-8 times a day during concomitant diseases, significant lifestyle changes, and during pregnancy.

In conclusion, it should be noted that it is desirable to periodically discuss the technique (preferably with a demonstration) of self-control and its regime with your doctor or a school employee of a diabetic, as well as to correlate its results with the indicator of glycated hemoglobin HbA1c. Glycated hemoglobin In addition to the direct assessment of blood sugar levels, there is a very useful indicator that reflects the average blood sugar level for the next 2-3 months – glycated hemoglobin (HbA1c).

Douglas Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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