Interference of home blood glucose measurements and poor outcomes: a solvable problem requiring broader exposure.

摘要

Wayne presented to the clinic for the first time in 18 months. It was clear something was different from the last visit. He looked thinner and the scale confirmed he had lost 15 pounds. His complexion was sallow with dark circles under his eyes, but he smiled winningly as ever, even as he explained how his recent kidney failure led to more frequent bouts of hypoglycemia, including one nocturnal seizure. His nephrologist recommended that he check with his diabetes care team before beginning peritoneal dialysis the following week. Based on readings from his home blood glucose meter, Wayne had decreased his insulin dosage since the last clinic visit. Although Wayne's current downloaded meter data revealed an average of 144 mg/dL, suggesting safe diabetes control, his standard deviation of 101 indicated the presence of major glycemic swings. His doctor noted an additional concern...