A number of audits to identify the incidence of self and staff monitoring of blood glucose in patients with diabetes when attending exercise therapy over a 2 week period

 

Mrs Catherine Davey1, Ms Catherine Giuliano1,2, Ms Mia Carrick1, Dr Elizabeth Skinner1

1Western Health, Footscray, Australia, 2Victoria University, Footscray, Australia

Catherine Davey a, Catherine Giuliano ab, Mia Carrick a, Elizabeth H. Skinner a,

a Western Health, Physiotherapy and Exercise Physiology, Melbourne, Australia. 

b Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living(ISEAL), Victoria University, Melbourne, Australia. 

Aim: Exercise and self-management are important components of best-care for patients with diabetes. Given the blood glucose level(BGL) lowering effects of exercise, guidelines recommend BGL monitoring pre and post exercise to minimise adverse events. Adherence to these recommendations is unclear. Furthermore, inpatient environments should promote patient self-management. The aim of this study was to measure the: i)incidence of BGL monitoring pre and post exercise, ii)occasions of BGL’s outside recommended range for exercise participation, iii)incidence of patient self-monitoring, and iv)possible barriers and facilitators.

Method: A number of audits of diabetic patients undertaking exercise over a 2 week period were completed in an inpatient rehabilitation setting.

Results: Patients with diabetes completed 79 sessions of exercise.  Of these, BGL’s were measured pre-exercise on 7 occasions(9%), and 20 occasions(25%) post-exercise. BGL monitoring was done by nurses (89% of occasions), with the remainder by the exercise physiologist or patient. Self-monitoring data was collected for 9 patients; none were using their own monitor or were self-monitoring regularly. BGLs exceeded the recommended range on 19 occasions; 3 due to hypoglycaemia.

Significance: We identified a risk of adverse events which could be prevented by greater adherence to best practice guidelines. There is a great reliance on nursing staff to achieve best-practice; however allied health could play a greater role in the context of exercise. Patient self-management is poor; further work is required to create an environment that promotes self-management.