Additional Physician Perspectives Related to Major Themes
| Proponents | Opponents |
|---|---|
| Theme 1. Education for Lifestyle Change | |
| Patient Activation | |
| “Over and over again, I have noticed that people who check their blood sugar tend to be more engaged in the self-management of their diabetes” (14). | “I tend to see the patients who keep monitoring are the ones who are generally more engaged around their self-care…. In my experience, [SMBG] has been mostly correlated with their level of activation rather than the disease” (10). |
| Patient-Centered Care | |
| “If I have somebody who is pretty much in the action phase of wanting to control their disease and their blood sugar is in the >9 category, I would be more aggressive with them checking and trying to manipulate the diet. But I’m very patient-centered, so I would ask them, ‘On a scale from 1-10, how important is it for you to check your blood sugar?’ If they say it’s 7-8 or 9, I would say, ‘Okay, what is your ideal state of checking a blood sugar.’ Then, I would see what they would say and do a confidence scale, ‘On a scale from 1-10, how confident are you that you can check your blood sugar?’ Let’s say they say 4 times a week. If I can get them above a 7, then I would go for it” (4). | “Usually, they are a bit hesitant [to stopping SMBG]…50% of patients don’t want to stop checking, because they are so used to it, so I will let them continue it. I won’t force them to stop” (5). |
| Theme 2. Value-Based Care | |
| Affordability for Patients | |
| “I take into account that I know these strips are very expensive, and for many patients, that’s a barrier. So I may tell them to check just once a day but at different times during the day” (13). | “This sounds painful and possibly expensive, you should stop and save your blood” (10). |
| Health Care System Costs | |
| “It helps to give us more short-term strategies to fix things rather than waiting for a three-month follow-up, when things can get ahead of us too far” (12). | “For those patients not on insulin, I think we are probably wasting a lot of money. We are doing tons of testing unnecessarily” (5). |
| Theme 3. Patient Safety | |
| “If a person is having symptoms that suggest hypoglycemia, then I would use [SMBG]. If we were able to actually avoid the hypoglycemia, then we can avoid potential cognitive damage or an injury related to hypoglycemia, like loss of consciousness and a fall” (8). | “I talk about a constellation of symptoms and when they might expect to feel those. It’s usually within a few hours of taking certain medicine or on days when they notice that they are skipping meals or that they are very sick from the cold. We talk a little bit about the general feeling of dizziness, lethargy, sweating, hunger, disorientation, and try to educate both the patient and whoever might be around them that these are signs or symptoms to look out for—to focus first on the intervention, which is go eat or drink something, but then also to check their blood sugar if they have time” (10). |
| Theme 4. Considerations for Specific Patient Populations | |
| “For a patient in their eighties who may have some cognitive disability, measuring their blood sugars every day or a couple of times a week, especially if they are doing well, may not really be very useful” (13). | “Some patients really need to see that number at certain times of the day, because it helps them become motivated to bring it down. Other ones, though, it’s the complete opposite. It interferes with their care, because they see it and they don’t understand” (6). |
SMBG = self-monitoring of blood glucose.