Self management of Type 2 diabetes: the role of blood glucose monitoring

1. Self management of Type 2 diabetes: the role of blood glucose monitoring Michael Craven, Jennifer Martin, Alexandra Lang, Sarah Sharples The University of Nottingham Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH)

2. Research has linked design, usability, error and patient safety • Now a legal requirement to address usability before a device is placed on the market • Focus has largely been on: • Safety • Devices used in clinicalenvironment • Clinical users • But what about devices used by patients / in the home or elsewhere, outside the clinical environment ...? Human Factors and Medical Devices

3. Home and Patient Use devices increasing in numbers • Ageing population • Telemedicine and assisted living • Reduce healthcare costs • Allow patients to remain independent for longer • However... little research on the human factors... • How can we ensure that devices and system are used: • Safely • Correctly • Regularly Patient Use Devices

4. Common patient testing task, • Performed by majority of type 1 • diabetics • Less common for type 2 diabetics • Devices provided free to NHS • Companies profit from long-term use of strips • Type 2 – compliance/adherence is an issue Blood Glucose Monitoring & Diabetes

5. Compliance of type 2 diabetic patients with • blood glucose testing • To investigate: • The human factors associated with blood testing • Factors that affect how (and how often) this is done • The role of blood glucose meters design in compliance • Whether there are particular device features that patients would be personally willing to pay for Aims and Objectives

6. Expert Elicitation – NHS scientist responsible for evaluation • Hierarchical Task Analysis • User Consultation • Semi-structured interviews and focus groups • 9 patients (7 male) • Age: 30’s – 70’s • Diagnosis: <6 months – 20 years + Methods

7. Simple? Rogers et al. 2001: Definitely Not “As Easy as 1, 2, 3” – 24 testing sub-steps. Task Analysis

8. Once-a-day ‘peace of mind check’ – “reassurance” • However, some patients have additional requirements: • Provides ability to “control” and “learn” about disease • “For me the control is back with this because I can now control my blood sugar levels pre and post exercise... without the blood sugar meter, I couldn’t. Because I didn’t know what was going on at all. No concept of what was happening.” • Experimentation – before and after eating/ drinking • Disconnect between aims of clinician vs. patients: leading to deception: • “I’ve stocked up on test strips so that I can • carry on testing even if they say I can’t” What is the objective of blood testing?

9. Variable... • Some given a sealed box to take away: “take one on your way out” • Process not clearly explained or discussed • “My doctor doesn’t know I have it, it was given to me • by the nurse.” • Little training – trial and error • Dependent on manufacturer instructions and internet: • “I went on to YouTube, I looked up Freestyle and they have a demonstration on there and that was really good. I thought that was great, it was visual” • Most not given a choice over which model they receive How are devices introduced?

10. Patients with type 2 diabetes are a diverse group • Different reasons for why they test • Different device requirements • Is small beautiful? • ‘Innovation’ seems to mean as small a device as possible • Suits younger/more active patients • 1 older patient reported using a 10 year old device due to dexterity and eyesight • Special needs not identified • Contrasted with reports of expert who highlighted availability of talking/larger displays for older/visually impaired patients Patients have differing requirements

11. Patients don’t view once-a-day testing as meaningful • Access to strips • Hand washing • “Trains are dirty and it is a problem. Have to do it in rail carriages, it is unhygienic in the loos … utterly disgusting.... I don't want to test in there”. • Changing requirements • Interestingly, pain and getting a blood sample not seen as an issue • “Does it hurt much? Not really no” Conclusion: Barriers to Compliance

12. What do patients want from devices? • How could they contribute to feelings of control/ independence? • Or conversely... excessive/ unhelpful worry or helplessness? • How does this compare with why they are prescribed...? • a • Feedback: how does short/long-term feedback influence: • How do patients know that a device is doing them any good? • Motivation, regular, correct and safe use. • How does this change over time? • a • ‘Concordance’: decisions are agreed by clinicians and patients • Shown to improve compliance/adherence with medication • Does it work for devices? • What about choice? • What support and training is needed? How should this change over time? Patient-use Devices: Future Research

13. Thank you for listeningAny Questions? www.match.ac.uk michael.craven@nottingham.ac.uk The MATCH partnership is core funded by the Engineering & Physical Sciences Research Council EP/F063822/1 MATCH - Renewal of IMRC Award GR/S29874/01 Multidisciplinary Assessment of Technology Centre for Health (MATCH) EP/F037775/1 Exemplar studies in assessing the value of innovative medical devices for adoption within the NHS