Diabetes Management: How to Make the Most of Each Clinic Visit With People Who Are Self-Monitoring Blood Glucose

It is important to make the best use of your visit with a person with diabetes. I like to use the acronym DATAA when I meet with someone to make sure I cover everything.

Optimize a Clinic Visit With a Person With Diabetes by Using the DATAA Mnemonic

• D is for data. Get the data from the handwritten log or connected glucose meter. Review the glucose targets, both fasting and premeal targets.
• A is for assessing safety. Look for lows, or glucose <70 mg/dL. It is important to know that hypoglycemia often leads to rebound hyperglycemia.
• T is for time in range. This should be the bulk of the conversation. Here, you want to focus on what is working well. Encourage the person with diabetes to try to replicate what is going on when the glucose range is 70-180 mg/dL. For example, people might notice that when they eat cereal or oatmeal for breakfast, their blood sugar spikes, but if they eat eggs or cheese, the levels stay much lower. Also, going for a walk after a big meal can cause the blood sugar to go back down.
• The second A is for areas for improvement. Always ask for permission before you talk about opportunities for improvement. Is there a reading out of range? What are possible solutions? Maybe they need a medication adjustment, need a food adjustment, or need to address activity or stress levels.  
• The last A is for action plan. Use shared decision-making to make a plan to increase time in range. Perhaps you can work on goals to increase activity or reduce stress. Then, make a plan for follow-up. The follow-up is very individualized. Some people may need to come back next week, whereas others might return in a month. It just depends on the plan.

Strategies to Get the Most Data From Blood Glucose Monitoring
If possible, try to have the person with diabetes wear a professional continuous glucose monitor (CGM) quarterly or twice yearly to give you more comprehensive data and help you make better decisions. But if CGM is not an option, ask the person to monitor blood glucose more intensely in the days before the clinic visit. They should do 4-7 finger sticks per day; 7 data points are very helpful. If people can only do 1 or 2 finger sticks per day, they can alternate when they check blood glucose. Paired testing before and after a meal and different times of day can give valuable information.

Finally, I would like to emphasize that blood glucose numbers are just data; they are not good nor bad. I would caution healthcare professionals not to act like a cheerleader when numbers are in range because people will feel bad when the numbers are outside of target and may miss the next appointment. Healthcare professionals and people with diabetes don’t need to be perfect. Remember, the guideline recommendation is to be in range 70% of the time.

Your Thoughts
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