The teratogenic effects of diabetes and the diabetogenic effects of pregnancy make tight glycaemic control during gestation essential. Regular review of the patients is neccessary though the short intervals between appointments make the relatively slow-to-change HbA1c unsuitable for making clinical decisions. Instead, the clinician must rely on home blood glucose (HBG)monitoring results from the patient. These depend on having an accurate meter and good technique aswell as honesty by the patient when recording their results. This can prove difficult and any simple method to facilitate this should be welcomed.
We describe one particular method with which we have particular experience and report on a retrospective analysis of the technique in 15 randomly selected patients.
From a finger stab for HBG monitoring the patients are taught to collect an extra 0.2-0.3 mls of the same blood into a fluoride oxalate coated tube (FOT). This is then stored in their domestic refrigerator before being analysed in clinic within a maximum of 32 hours. The results of the samples are compared with the FOT sample acting as a quality control check on the HBG sample from the same spot of blood.
Fifteen patients records were reviewed (14 with type 1 and 1 with gestational diabetes). A mean of 17.4 clinic visits were made each (14-20) and 833 from an expected 1048 FOT samples were returned (mean 79.4 %, range 59-100%). This involved a total cost of £758 (£50.50 each). No patient to our knowledge has refused to partake in the scheme and no major difficulties have ever been reported.
By encouraging compliance an patient participation and discouraging HBG result fabrication we believe this is one acceptable, simple solution to a complex and longstanding problem.
03 - 04 Dec 2001
Society for Endocrinology