Thomas Zueger1, Manuel Gloor2, Vera Lehmann2, Andreas Melmer2, Mathias Kraus3, Stefan Feuerriegel3, Markus Laimer2, Christoph Stettler2. 1. Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Management, Technology, and Economics, ETH Zurich, 8006 Zurich, Switzerland. Electronic address: thomas.zueger@insel.ch. 2. Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 3. Department of Management, Technology, and Economics, ETH Zurich, 8006 Zurich, Switzerland.
Abstract
BACKGROUND: White coat adherence (WCA) is defined as an increased adherence to treatment regimens directly before a visit with a healthcare provider. Little is known on the effect of WCA on glucose control in adult patients with diabetes mellitus. METHODS: The present study is based on 618 CGM-observations of 276 patients with diabetes treated between January 2013 and July 2018. The analysis compares data from the 3 days prior to a visit (p1) with the preceding 25 days (p2). RESULTS: Sensor use was higher during p1 than p2 (92.8 ± 7.3% vs 88.8 ± 7.5%; p < 0.001). Mean glucose [MG] and coefficient of variation [CV] were lower in p1 compared to p2 (MG 163.9 ± 39.2 mg/dL vs 166.9 ± 35.7 mg/dL, p = 0.001; CV 33.5 ± 8.4% vs 36.0 ± 7.0%, p < 0.001; respectively). Time in range (70-180 mg/dL) was higher in p1 than p2 (61.4 ± 21.2% vs 60.0 ± 18.4%, p = 0.002). Sensitivity-analysis showed that WCA effect was mainly detected in patients with HbA1c > 7% [53 mmol/mol]. CONCLUSION: This study reveals a WCA effect on pre-visit glucose control in adult patients with diabetes. The effect was most pronounced in patients with moderate to poor glycemic control. In these patients, analysis of CGM data should encompass a minimum of 1 to 2 weeks prior to a consultation.
BACKGROUND: White coat adherence (WCA) is defined as an increased adherence to treatment regimens directly before a visit with a healthcare provider. Little is known on the effect of WCA on glucose control in adult patients with diabetes mellitus. METHODS: The present study is based on 618 CGM-observations of 276 patients with diabetes treated between January 2013 and July 2018. The analysis compares data from the 3 days prior to a visit (p1) with the preceding 25 days (p2). RESULTS: Sensor use was higher during p1 than p2 (92.8 ± 7.3% vs 88.8 ± 7.5%; p < 0.001). Mean glucose [MG] and coefficient of variation [CV] were lower in p1 compared to p2 (MG 163.9 ± 39.2 mg/dL vs 166.9 ± 35.7 mg/dL, p = 0.001; CV 33.5 ± 8.4% vs 36.0 ± 7.0%, p < 0.001; respectively). Time in range (70-180 mg/dL) was higher in p1 than p2 (61.4 ± 21.2% vs 60.0 ± 18.4%, p = 0.002). Sensitivity-analysis showed that WCA effect was mainly detected in patients with HbA1c > 7% [53 mmol/mol]. CONCLUSION: This study reveals a WCA effect on pre-visit glucose control in adult patients with diabetes. The effect was most pronounced in patients with moderate to poor glycemic control. In these patients, analysis of CGM data should encompass a minimum of 1 to 2 weeks prior to a consultation.
Authors: Eric K P Lee; Paul Poon; Benjamin H K Yip; Yacong Bo; Meng-Ting Zhu; Chun-Pong Yu; Alfonse C H Ngai; Martin C S Wong; Samuel Y S Wong Journal: J Am Heart Assoc Date: 2022-09-03 Impact factor: 6.106