Article: Care Delivery
Experiences of using blood glucose targets when following an intensive insulin regimen: a qualitative longitudinal investigation involving patients with Type 1 diabetes
Article first published online: 15 JUL 2012
© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK
Volume 29, Issue 8, pages 1079–1084, August 2012
How to Cite
Rankin, D., Cooke, D. D., Heller, S., Elliott, J., Amiel, S., Lawton, J. and for the UK National Institute for Health Research (NIHR) Dose Adjustment for Normal Eating (DAFNE) Study Group (2012), Experiences of using blood glucose targets when following an intensive insulin regimen: a qualitative longitudinal investigation involving patients with Type 1 diabetes. Diabetic Medicine, 29: 1079–1084. doi: 10.1111/j.1464-5491.2012.03670.x
- Issue published online: 15 JUL 2012
- Article first published online: 15 JUL 2012
- Accepted manuscript online: 4 APR 2012 12:42PM EST
- Accepted 30 March 2012
- blood glucose targets;
- intensive insulin therapy;
- qualitative longitudinal research;
- structured education programme;
- Type 1 diabetes
Diabet. Med. 29, 1079–1084 (2012)
Aims Use of blood glucose targets is considered essential to help patients with Type 1 diabetes achieve tight glycaemic control following structured education. To foster effective use of blood glucose targets, we explored patients’ experiences and views of implementing clinically recommended blood glucose targets after attending a structured education programme promoting intensive insulin treatment.
Methods Repeat, in-depth interviews with 30 patients with Type 1 diabetes recruited from Dose Adjustment for Normal Eating (DAFNE) courses in the UK. Data were analysed using an inductive, thematic approach.
Results Patients found use of blood glucose targets motivational. Targets enabled patients to identify problems with blood glucose control and prompted them to make insulin dose adjustments independently, or with assistance. However, patients tended to adapt or simplify targets over time to: make them more attainable and easy to remember; reduce risk of hypoglycaemia; and, mitigate feelings of failure when attempts to attain clinically defined targets were unsuccessful. Some patients were advised to use elevated targets to counter hypoglycaemia unawareness and required help from health professionals to determine when/if these should be reduced.
Conclusions Although blood glucose targets are an important component of diabetes self-management, patients may adapt and personalize them over time, sometimes inadvertently, with a potentially detrimental impact on long-term glycaemic control. Blood glucose targets should be regularly revisited during clinical reviews and revised/new targets agreed to accommodate patients’ concerns and difficulties. Other interventions may need to be considered to promote effective use of blood glucose targets.