Posted Jan 3 , 2018 04:48 AM

Examining the Impact of a Novel Blood Glucose Monitor with Color Range Indicator on Decision-Making in Patients with Type 1 and Type 2 Diabetes and its Association with Patient Numeracy Level

Grady M, et al. Journal of Medical Internet Research-Diabetes 2017;2:e24

What were the findings (excerpted from the Abstract)?

Many people with diabetes struggle to interpret and respond appropriately to the numerical blood glucose results displayed on their meter, with many regularly taking no action or self-care adjustment for out-of-range results. The authors recently reported that a glucose meter that provides automatic onscreen information using a color range indicator (ColorSure Technology) improved the ability of patients to categorize their blood glucose results. The objective of the current study was to examine how ColorSure Technology (or color) affected patient decision making on blood glucose results and how patient numeracy levels influenced such decisions. The authors invited 103 subjects (56 with type 2 diabetes and 47 with type 1 diabetes) to a face-to-face in-clinic visit in a diabetes care center and showed them glucose results with or without color via interactive computer or paper logbook exercises. Before participating in these exercises, subjects completed surveys on numeracy and their understanding of blood glucose information. Subjects preferentially acted on high glucose results shown with color (55%), compared to results without color (45%). When shown identical pairs of results, subjects preferentially acted on results shown with color (62%,) compared to results without color (16%). Subjects more accurately identified days of the week in which results were low, in range, or high when reviewing logbooks with color (83%) than without color (68%). In each case, the differences were statistically significant. Subjects with lower numeracy were more likely to consider acting on high glucose results shown with color (59%) than without color (41%), and preferentially acting on results shown with color (71%) compared to results without color (16%). Insulin- and noninsulin-using subjects were each more inclined to act when glucose results were shown with color, and associating glucose results with color was viewed as particularly beneficial by subjects with lower numeracy.

Why is this important?

Most practitioners involved in diabetes care are aware that health literacy and numeracy are an issue with a significant number of people. Health numeracy issues and measures available have been extensively reviewed by Reyna et. al. [available online] (Psychol Bull. 2009 Nov; 135(6): 943-973). The fact remains that numeracy skills or at least perceptions of numbers are important to make appropriate decisions on various aspects of therapy from diet to exercise to medications. With most everyone familiar with stoplight colors and meanings, using them along with the actual numbers helps patients better understand the meaning of those numbers and making appropriate decisions. This study clearly shows that patients can act on values more appropriately if they are put in context with known color representations of certain values.

Do you have patients with numeracy issues? What methods have you used to overcome some of the barriers these issues signify? Would color coding of numbers help your patients?

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