CLINICAL DIABETES These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. PRACTICAL POINTERS How to Communicate Home Blood Glucose Monitoring Data More Effectively: A 'Low-Tech' Fax Solution to a Common Diabetes Data Management Dilemma Timothy S. Bailey, MD, FACP, FACE Data generated from patient care inundates most physicians' offices. This morass is outpacing the ability of most people to transform data into useful information. The field of diabetes care is arguably the most chronically data-intensive discipline in medicine. This is in large part attributable to the availability and use of home blood glucose monitoring technology. The ability of people with diabetes to monitor blood glucose levels is an essential component to achieving the good glycemic control known to prevent end-organ complications in both type 1 and type 2 diabetes.1,2 With the advent of minimally invasive devices that allow near-continuous monitoring of blood glucose levels, it is clear that the data glut will be with us for a long time unless we improve our approach to data management. The purpose of this article is to discuss the role of the fax machine as part of a more inclusive communication strategy to enable superior diabetes care. In a previous issue of Clinical Diabetes, Dr. Irl Hirsch discussed his extensive experience with the use of glucose monitoring data in clinical practice.3 I strongly agree with his perspective that all patients' meters be routinely downloaded to a computer for analysis at each office visit. A feature of software I find essential is the capability to summarize the meter data in a single-page graphical summary and logbook automatically. With the great variety of downloadable meters to choose from, it is also important to select software that can accept and integrate data from multiple devices. Computer-generated printouts are much easier to interpret because they improve legibility and enforce a consistent format. These printouts can be very helpful to patients at home for self-inspection and for relaying information to diabetes care professionals. A standardized method of data presentation, once learned, makes patterns easier to detect for all parties. When downloading is performed at home, patients can add important supplementary data that are not always well stored in the meters themselves, such as insulin doses, food intake, exercise, and comments. A further benefit of home downloading is that it saves time for the clinic's office staff. Despite my enthusiasm, I have not been able to convince all of my patients to download their own meters. Barriers to adoption of home downloading include failure to appreciate its value, lack of a computer, and lack of a cable to connect the meter to the computer. Efforts to move the locus of blood glucose analysis to the home will succeed only when the technology becomes easy, economical, and perhaps even enjoyable. A common occurrence in the office of anyone who cares for patients with diabetes is having patients who telephone to ask advice regarding the correction of abnormally high or low blood glucose levels. In many offices, a staff member records the glucose values dictated by the patient, retrieves the patient's medical records, and presents this to a designated health care professional. The designated professional (or another member of the staff) then returns the patient's call with therapy recommendations. Although technology exists to automate this type of interaction, few centers have actually implemented it. How do you manage this common situation? In our office, I found that my staff took a variety of approaches. However, not all of these were optimally effective. I was intrigued by the finding of a small survey of endocrinologists that showed that 100% ask their patients to fax their logbooks to their offices (unpublished data, 1998). I designed a new faxable logbook sheet for my patients to use, since most logbooks now available have a saddle-stapled design that precludes their entry into a fax machine without disassembly or copying. The Patient Information page that accompanies this article (p. 87) is a reproduction of our single-page faxable logbook. (It is also available in electronic format to print out at your computer at the following web site: www.metamedix.com.) The faxable logbook contains these important elements:
The suggested use of this tool is as follows:
4 . The sheet is faxed back (or the recommendations telephoned) to the patient by the physicain or staff. Perhaps the most interesting comments we received were that patients actually liked this structured approach better than telephoning in the data because the former was easier for them, also. A further surprise was that, while not all patients have a dedicated fax at their home, there is near-universal access to such a device among friends, neighbors, coworkers, and local shops. The lessons we learned from this simple project were that there is a danger of underestimating our patients' capability to use technology and that any new procedure we implemented would be successful only if all parties benefited. We need more tools that have similar "win-win" characteristics. REFERENCES 1The DCCT Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977-86, 1993. 2UK Prospective Diabetes Study Group: Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837-53, 1998. 3Hirsch IB: How to use home blood glucose monitoring data most effectively. Clinical Diabetes 16:194-95, 1998. Timothy S. Bailey, MD, FACP, FACE, is a clinical endocrinologist in private practice in San Diego, Calif., an assistant clinical professor of medicine at the University of California, San Diego School of Medicine, and chief executive officer of MetaMedix, Inc. Copyright © 1999 American Diabetes
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