Type 2 Diabetes Mellitus: Patient Education and Self-monitoring of Blood Glucose

00:00 Moving on to guidelines for the management of diabetes mellitus in general always start from a multidisciplinary approach. First of all, patient education and support is vital. Second, lifestyle modifications with diet and exercise with the aim to reduce calories for all overweight and obese patients a must, and then finally pharmacological therapies to meet individualized glycemic goals.

00:29 Patient education consists of diabetes self-management and diabetes self-management support. These steps are recommended at the time of diagnosis of prediabetes or overt diabetes and throughout the lifetime of the patient. Diabetes self-management education is an individualized plan that provides opportunities for educational and motivational support for diabetes self-management that is going to consume the rest of the lifetime of the patient. Assess all patient's educational needs and abilities, develop a personalized treatment plan for each patient, learn self-management skills and help the patient develop a way to integrate them into their lifestyle, and then provide ongoing psychosocial and clinical support to ensure that the patient's blood sugars are adequately controlled. Improved outcomes and reduced costs have been associated with this approach.

01:29 Self-monitoring of blood glucose is recommended for patients on multiple daily injection therapy or continuous subcutaneous insulin infusions usually in the form of an insulin pump. Fingerstick glucose measurements are performed frequently in the pre-meal time, at bedtime, pre and post exercise, whenever symptoms of hyper or hypoglycemia develop, and before important activities such as flying a plane or driving a school bus. Monitoring blood glucose levels 1-2 hours after food consumption, sometimes known as postprandial fingersticks, are useful to assess prandial insulin coverage in patients with good preprandial readings but with a hemoglobin A1c which is not at goal. So here you would have blood sugars that are reasonably good in the short term but when assessed with a hemoglobin A1c which reflects your glucose management over the course of 3 months the patients require more insulin. Self-monitoring of blood glucose can also be performed by overnight blood glucose monitoring which can help to detect hypoglycemia or the dawn phenomenon as we discussed earlier. It can also help with insulin dose adjustments and changes in meal content or changes in activity level to reach glycemic goals usually in the form of increasing activity level. The data for the role of cost effectiveness are less clear for regimens without multiple daily dosing injections and non-insulin regimens.