Pattern management: A four-step approach to better outcomes
Pattern management is the systematic interpretation of self-monitored blood glucose (SMBG) results and contextual data over time to help you and your patients identify glycaemic deviations. Using patterns identified in SMBG data to identify potential therapy changes can improve your patients’ overall glycaemic control1,2.
Following this four-step approach to pattern management could help you to ensure you are focusing on the right areas:
- Identify the out-of-range results: Use the patient's SMBG data to identify all out-of-range results:
- First, look for any hypoglycaemic events
- Secondly, focus on fasting or preprandial hyperglycaemia; prioritise fasting results above the target range, then assess any preprandial hyperglycaemia
- Thirdly, look at any postprandial hyperglycaemic episodes, specifically values more than 2.8 mmol/L (50 mg/dL) higher than the related preprandial values
- Determine timing and frequency: Two or more episodes in any of the areas mentioned above indicate an out-of-range result that must be treated.
- Look into causes: Talk with your patient about the patterns you have identified. Ask if they did anything around those times that could have affected their glucose levels. These conversations are your opportunity to help them better understand the direct connection between food, exercise, or behaviour choices and glycaemic management.
- Take action: Address one area at a time. If a patient has more than one area of focus, address the most significant one first (e.g. concentrate on hypoglycaemia before hyperglycaemia). Base your therapy recommendations on their SMBG data and your discussion of glucose-impacting behaviours.
If your patients are finding managing their diabetes difficult or overwhelming, the Accu-Chek blog has content to help with a variety of topics, from mental health, to diet and exercise. Other resources to help your patients with SMBG can be found here.
Understanding SMBG results
The goal of structured SMBG activities and the pattern management process is better understanding and control. While the action you take depends on each patient and situation, consider the following talking points when reviewing SMBG results with patients and determining therapy and behaviour recommendations.
If your patient has frequent low or low-to-normal fasting or postprandial glucose, review their medications and lifestyle factors:
- Try to figure out if drugs with a lower risk profile for hypoglycaemia should be considered
- Talk about how to manage hypoglycaemic events and how to recognise the signs and onset of low glucose levels
- Discuss non-medication-related factors that might lead to hypoglycaemic events, and ask them for feedback about their lifestyle and general health status and factors
If your patient has frequent hyperglycaemic glucose levels, talking points could include:
- Educating them on the clinical consequences of frequent hyperglycaemia, such as on cardiovascular health
- Reviewing medications that can cause hyperglycaemia
- For patients with fasting/preprandial hyperglycaemia, discussing strategies for reducing glucose levels, such as regular exercise or dietary changes like reducing starches and sweets
- For patients with postprandial hyperglycaemia, discussing strategies for choosing low glycaemic index foods, monitoring portion sizes during meals, and in some cases, carbohydrate intake.
The Accu-Chek® 360° View Tool provides an easy-to-follow downloadable paper tool to help provide your patients with a monitoring plan and collect information to help support a meaningful discussion of their results. By following these steps and using these talking points to ensure your patients understand how to collect, review and apply SMBG results, you can set your patients up for success in managing their diabetes.
Polonsky WH et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study. Diabetes Care. 2011;34:262-7.
Pearson J, Bergenstal R. Fine-tuning control: pattern management versus supplementation. Diabetes Spectrum. 2001;14:75–8.