Home Monitoring of Glucose and Blood Pressure

Home monitoring of blood glucose and blood pressure levels can provide patients and physicians with valuable information in the management of diabetes mellitus and hypertension. Home monitoring allows patients to play an active role in their care and may improve treatment adherence and clinical outcomes. Glucose meters currently on the market produce results within 15 percent of serum blood glucose readings and offer a variety of features. Although the data are somewhat conflicting, home glucose monitoring has been associated with improved glycemic control and reduced long-term complications from diabetes. These effects are more pronounced in patients who take insulin. Home blood pressure values predict target organ damage and cardiovascular outcomes better than values obtained in the office. Home blood pressure measurements are also effective at detecting borderline hypertension and monitoring the effectiveness of antihypertensive drugs. Validated arm cuffs are the preferred blood pressure devices for home use. Information from home monitoring should always be used in conjunction with that from regular office visits and other data to make appropriate therapeutic decisions.

Home monitoring of blood glucose and blood pressure levels can provide the patient and physician with valuable information for disease management. Because a variety of home monitoring devices are available, appropriate selection and use can be a daunting task. This article reviews devices for home monitoring of glucose and blood pressure and discusses their clinical utility.

Glucose Monitoring

Although there is no universal standard for accuracy of glucose meters, several groups have defined acceptable ranges. The U.S. Food and Drug Administration (FDA) requires glucose meters to produce self-monitoring results within 20 percent of a reference measurement but recommends results within 15 percent; the FDA has stated that future meters should achieve results within 10 percent of reference at serum glucose concentrations of 30 to 400 mg per dL (1.7 to 22.2 mmol per L). The American Diabetes Association (ADA) recommends that meters produce readings within 5 percent of laboratory values. All meters currently on the market are considered to be clinically accurate in that they at least meet the FDA standard, although it is important to remember that they are not as accurate as a standard laboratory test. Given this broad range of possible error, making treatment decisions based solely on self-monitoring of blood glucose (SMBG) is not advised.

Glucose meters are most accurate when used properly. Thus, educating patients on proper use and what to do with the results is vital. Although the exact procedure for using a meter varies by product, potential pitfalls are similar. Common errors include poor maintenance (e.g., soiled meter), using expired test strips, obtaining an inadequate sample size, and failing to calibrate the meter.

CLINICAL UTILITY

downloadUses of SMBG data include identifying and treating hyper- and hypoglycemia; making decisions about food intake or medication adjustment when exercising; determining the effect of ingested food on blood glucose; and managing glucose fluctuations resulting from illness. Although the data are somewhat conflicting, larger, better-designed trials have shown that SMBG improves glycemic control when the results are used to adjust therapy. However, the data for reducing long-term complications are more conclusive for patients on insulin therapy.

Although the optimal frequency of monitoring is unknown, the ADA recommends SMBG three or more times a day for patients with type 1 diabetes. Patients with type 2 diabetes still benefit from at least periodic monitoring. Ultimately, the frequency and timing of SMBG should be determined by how the data will be used. SMBG can assist the patient and physician with adjusting diet and medications and maintaining appropriate glucose control. More frequent monitoring is beneficial during insulin dose adjustments. Postprandial monitoring is important to identify the effect of various foods on glucose levels and to monitor the effects of preprandial medications. Other factors, such as desire for tight control and current degree of control, will influence frequency of monitoring.

METER SELECTION

A number of glucose meters are available, with new models being released each year. Although home glucose meters use whole-blood samples, nearly all are plasma calibrated so that the results reflect plasma glucose. This allows home values to be compared directly to laboratory values. Glucose meters are largely differentiated based on their features. These include blood sample size required, test time, memory capability, ability to download results into data management software, and ability to perform alternate site testing (e.g., forearm). Meter selection should be based primarily on features desired by the patient.

Newer technology has led to the development of continuous glucose meters that measure glucose in subcutaneous interstitial fluid and reflect changes relatively quickly. However, continuous monitors are not easily used on a long-term basis, and their current clinical utility is somewhat limited. Prices of most glucose meters and strips are comparable. However, patients often can purchase the meter for little or no cost after rebates. The long-term expenses come from the strips and other supplies. A few meters offer more advanced features, such as the ability to enter information (e.g., medication doses, carbohydrate intake, exercise) and voice prompts for the visually impaired.

Blood Pressure Monitoring

intel-health-guide-blood-pressure-monitoringElectronic devices are available to measure blood pressure at the arm, wrist, or finger. Published data evaluating the accuracy of specific electronic blood pressure monitors are limited. However, several organizations have established standards for accuracy.  Devices available in the United States that are known to meet these criteria. Clinical evaluations of wrist and finger devices have revealed that these instruments are considerably less accurate than their arm (brachial artery) counterparts, with finger monitors being the least accurate.

CLINICAL UTILITY

Office-based blood pressure measurements have been shown to result in higher values than those recorded at home. Studies have found variations of 9 to 23 mm Hg in systolic blood pressure and diastolic differences of 3 to 10 mm Hg. The most recent report from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) defines home blood pressure values consistently greater than 135/85 mm Hg as hypertensive. The differences in systolic pressure between home and office blood pressure measurements increase with age and degree of anxiety during office visits (known as “white coat” hypertension). These differences also tend to be greater in men and in patients not taking antihypertensive medication.

A systematic review concluded that, compared with office monitoring, home monitoring is better at predicting target organ damage and cardiovascular mortality, predicting sustained hypertension in patients with borderline hypertension, and can be used to monitor drug effectiveness. This evidence is based on the use of validated blood pressure monitors. Although there are no evidence-based recommendations on frequency of home blood pressure measurements, it has been suggested that the minimal number of measurements to obtain an accurate assessment of a patient’s usual blood pressure should be four times per day (twice in the morning and twice in the evening) for three consecutive days.

MONITOR SELECTION

Although there are limited comparative data on specific blood pressure monitors, home monitoring offers several advantages in addition to its correlation with outcomes and drug effectiveness. It eliminates the white coat effect, allows for multiple readings, and may improve patient awareness and compliance with treatment. There are, however, a few limitations. Some home devices may not be appropriate in obese patients (because of limited cuff sizes), patients with arrhythmias or preeclampsia, and patients in whom vascular stiffening is suspected. In a recent randomized controlled trial, adjustment of antihypertensive medications based solely on home monitoring led to less-intensive drug treatment and poorer blood pressure control than usual care. Medication adjustments should incorporate values from home and office monitoring.

Electronic blood pressure models are relatively easy to use and display a digital readout. They may be semiautomatic (i.e., patient inflates and deflates cuff) or fully automatic (i.e., cuff inflates and deflates with the press of a button), although both types automatically measure the blood pressure. Electronic blood pressure readings correlate well with the auscultatory method.21  Despite the relative ease of using electronic blood pressure monitors, failure to follow protocol can lead to erroneous results.

ARTICLE SOURCE: This factual content has not been modified from the source. This content is syndicated news that can be used for your research, and we hope that it can help your productivity. This content is strictly for educational purposes and is not made for any kind of commercial purposes of this blog.

Diabetic Diet Plan And Food Guide

Diabetic Diet Basic
Eating-healthy-and-exercising-are-the-best-ways-to-reduce-diabetes-risk--but-few-follow-through-_16000697_800813846_0_0_14007151_300The basics to diabetic diet meal planning are simple once we understand the way our body breaks down food. Everything we eat is broken down into sugar eventually. Sugary foods such as sweets or fruit hit the bloodstream almost immediately, followed by the slower starches (carbohydrates, or carbs), which take an hour or two to break down depending on their complexity. Proteins are next, taking about four hours, then between six and eight hours the fats finally break down. If strict attention is paid to diet and exercise, many diabetics can control their blood sugar with minimal dependence on medication.

Diabetic Diet Plan And Goal
Diabetic diet plan differ from person to person due to our daily nutritional needs and type of diabetes a person suffers. Following are the most common type of diabetes diet:

  • Type 1 Diabetes Diet – Type 1 diabetes always requires insulin treatment, the main focus is to find a balance between the food intake and insulin.

  • Type 2 Diabetic Diet – Type 2 diet focus on controlling weight in order to improve the body’s ability to utilize insulin. In most cases Type 2 diabetes can be controlled through proper diet and exercise alone.

  • Gestational Diabetes Diet – unlike the Type 2 diet, gestational diabetes diet focus on adequate energy and nutrients to support both the mother’s body and growing baby while maintaining stableblood glucose levels for the pregnant mother.

The diet goal is to eat a balanced, portion controlled meal that will allow our body to stay on an even keel throughout the day as the components of each meal hit the system. Eating every two to three hours is best, five or six small meals being recommended, and light exercise after each meal will help kick start the digestive system and prevent a spike in sugar levels. If we can include appropriate servings from each food category at each meal, they will break down at different rates, delivering a steady trickle of sugar into the bloodstream and keeping our energy level stable. This saves our system from having to deal with a great influx all at once, as it would if we ate only carbs, or only protein.

Diabetic Diet Sample Meal And Food

The ideal diabetic meal will consist of a combination of foods. Some foods cross categories, like bread products that are high in fat, dairy items that provide protein, and starchy vegetables. Our needs will vary depending on the time of day and how much physical activity we engage in. Following is a sample diabetic diet meal :

One serving of protein (3 oz of chicken, lean beef or fish)
One serving of bread (whole grain roll, tortilla or ½ cup pasta)
One serving of dairy (cheese, milk or low-fat sour cream)
One serving vegetables (fist sized portion or a small bowl of salad)
One serving fruit (tennis ball sized or ½ cup sliced)
Small amounts of unsaturated fats are needed, so add a little dressing or a pat of soft margarine. Avoid sweets; consider the fruit your dessert!

Foods that should be avoided include; fatty red meat, organ meat, highly processed food, fried food, fast food, high cholesterol food and foods rich in saturated fat.

ARTICLE SOURCE: This factual content has not been modified from the source. This content is syndicated news that can be used for your research, and we hope that it can help your productivity. This content is strictly for educational purposes and is not made for any kind of commercial purposes of this blog.