BG Diary at Clinic

Hello StewB ..thanks for your comments, I agree entirely – but I have tried 2 or 3 times to encourage my hcp to sign up to DO but without any success, she advises due to short staff time pressure. I also tried emailing a copy but that did’nt work either. At the last review ( 1 hour for 5 people) there also was just not enough time for review of full diaries.

Like you, I also go to review with a query list but it’s obviously based on my own analysis rather than an expert view and we are really looking for guidance on what steps to take to further improve.

As far as any hcp summary is concerned it seems to me that a table of weekly Average BGs' at various key times , Average QA's & BI Dosages, Ratios Used and Our Comments were included as trend indicators and summary of changes already made, then No of Hypos, No of high rdgs etc would serve as indicators of potential problems to an hcp well aware of typical stats on these.

For a 12 week review, perhaps weekly stats so perhaps 20 lines in total. For longer periods monthly would seem the only option.

It seems very important that the Dafne review works effectively as, as at my last Clinic review, the registrar made clear that he was now concerned only with the diabetic effects on the body and would leave BG control to Dafne staff.

But really, as said before, we really need an hcp to specify what info would be timely and effective for them to pre-review in order to initiate any problem resolution at the review. Otherwise we (Simon!) could waste effort producing something which is not what is required. Unless we try the stalking horse approach .. produce something to provoke hcp constructive criticism.

Anybody have a tame hcp (with some free time) to hand?

John,
Can I just clarify when you talk about your HCP not having time and the review only lasting an hour are you talking about DAFNE reviews or your normal Diabetes Clinic reviews. The whole point of DAFNE is its a tightly controlled and audited programme where the standard of support and care is supposed to be the same regardless of location. Having a review that only lasts an hour is NOT my experience of DAFNE.
I would be very interested to learn if this IS the case in your area both from a DAFNE Online perspective and from my role in the DAFNE User Group.

Hi marke .. I'll send you some clarification by message. Cheers, John

Hi All,

Here is a suggested spec for a basic HCP summary: suggest it’s located on the Diary view page and generates a tabular result.
The process summarises analyses already available on a date by date basis plus few other bits.
To be effective needs Diary entries to be filled fully inc significant comments on ratio changes, CP errors etc .

Needs a User selected high reading level X specified to suit their situation.

The User specifies a start date and no of weeks to be covered by the table.
7 day’s records are averaged and summarized per line of a table with column headings:

Start Date, Avg Daily QA taken, Avg Daily BI taken, Avg Breakfast BG, Avg Lunch BG, Avg Dinner BG, No of rdgs< 3.5, No of rdgs> X, Avg Bkf ratio, Avg Lun ratio, Avg Din ratio, Comments for all 7 days

The Ratios are the tricky one. If the avg ratios per Type are calculated, need to either use the entered ratios or calculate using the CPs and QA data entered (if in a + b format). The former seems easier. I always note ratio changes in Comments, but other info also. Perhaps Ratio handling need a rethink in due course?

For longish diaries it might be good to eventually to offer a separate but similar previous month by month analysis for longer term comparison. But no doubt better to get the basics out for feedback first.

Using my own data, this was easy to see trends and impact of dosage changes made.. as long as these were recorded in Comments! The comment lists gave a review of how I was trying to attack BGs over time. One surprising thing I noted was that although the averages were generally coming down, as was the no of rdgs >12 (doh!), the trend of rdgs <3.5 stayed the same, either 1, 2, or 3. Go figure.

Anyway, interesting to see if you think this can be done without too mush hassle and then see user response. I’m off to a Dafne Review next week and am taking my own manual version along so will see what the hcps think!

Cheers, John

Hi Everyone,

We've just updated the site with a summary view for the diary - see the link at the top of your Blood Glucose diary view (near links to help and add multiple).

It's a first pass, so the current information displays:

BG Averages at different times of day
Average insulin dosage per day
How many times your BG has been above/below target thresholds.
How many entries make up the current summary

Currently still to do:

Summarizing comments, and ratios - these are a little trickier, as the ratios will require some calculation, and the comments may take up a lot of space, we need to work on the best way to display them.

Also, the insulin dosage averages do not take into account any corrections - only numbers before any '+' or '-' characters. I wasn't sure whether people wanted to take corrections in to account or not, your feedback would be appreciated on this.

Finally I thought it would be nice if you could view the detailed diary view for a summary by clicking on the summary's date - so you can!

As always, let us know what you think.

Thanks,

Simon

Hi Simon,

Just finished inputting my BG onto my diary and think that the summary view is absolutely brilliant!!!

It is great to be able to see the average BG for different times of the day in number format. Personally I don't think the fact that the average insulin doses don't take into account corrections is a problem. Its just great to see everything summarised so easily. I though the graphs were good but I think this is even easier to read.

Great work again guys.

Big thanks.

Karen x

Hi Simon…

Excellent for the first pass from a sketchy specification! Drill down good and a natural requirement when looking at ‘odd’ results .. some of us have lots of those!

Maybe would be good to have a user definable Hi setting in due course from user point of view, but hcps may prefer to use the dafne bkf 7.5, lun 7.5, bed 8.0 for their report, if eventually slightly different.

Main comment is that the same data would be more usefully displayed with a compact single line per week The abbreviated column headings would need to be explained first.

Week QA BI Bkf Lun Din Bed Lo Hi EC
19/10/09 22 33 9.6 10.6 5.5 12.8 3 17 34
26/10 09 31 33 8.3 9.6 8.5 10.1 1 10 31
etc,
and at the bottom
average 28 33 10.5 10.2 8.3 7.9 2.2 13 33

This format makes much easier to see trends by reading down a column and then focus on one aspect, eg Bkf BGs for improvement.

The + - QA correction info would be very useful, to indicate when BI perhaps needs to be changed, especially bearing in mind the info is intended not just for us on a day to day basis, but for periodic hcp review.

As the Correction value is usually small, perhaps include the Total QA ‘+’ Corrections as a guide to the ‘+’ correction activity relative to the avg QA taken. Drill down could then used to investigate if too high. Or maybe QC as a % of QA taken would be better,

Week QA QC BI Bkf ............
19/10/09 22 8 33 9.6 ….........

I would tend to handle the ‘-‘ separately, as a wide lifestyle range of reasons. Not sure if much can be done from analysis.

As posted before, Avg Bkf ratio, Avg Lun ratio, Avg Din ratio indicators are needed but change relatively slowly and infrequently. So perhaps a separate listing, better showing the Actual ratios (not Avg) in force at the end of first week displayed and at the end of any week in which there has been a change to any ratio. This would be sufficient indication/reminder of the dosage strategy being followed. Eg

Week Bkf Lun Din
19/10/09 1.0 1.0 1.2
02/11/09 1.0 0.6 1.2
09/11/09 1.0 0.8 1.2

I only usually enter 3 or 4 short Comments per week, usually explanatory for specific odd result or strategic decision to change BI. If other users have a similar qty then, if space problem on the main listing, comments could be relegated to a separate weekly listing to refer to if oddity in the main or Ratio listing prompts this. Or possibly combine with the Ratios listing above; although that would probably mean all weeks would be listed.

Week Bkf Lun Din Date-Comment1 Date-Comment3 Date-Comment3
19/10/09 1.0 1.0 1.2 21- battery flat 22-instn pm 23-running

I f space generally is a problem, Entry Count is less important, I would say.

Once again , a great start.. and hope these comment help . Cheers, John

Thanks for your comments Karen and John. I'll feed your requirements into the next version of the summary.

John - one thing, you can specify your own 'low' and 'high' threshold values via the text boxes at the top of the summary - is this what you mean?

Also - with regard to the ratios, would it be OK to report on the most commonly used ratio for each time of day, rather than a calculated average? This would be easier to add I think.

Cheers,

Simon

Simon..

With regard to Min/Max – memo to me .. look at the options available more closely!

Re ratios, I suspect my request was a bit jumbled. I was not asking for Avg ratios at all, but merely the given end-of week ratio result(s) .

If a ratio is not available for the last day reported, then use the last value that is given. ..in fact that sounds the better rule anyway, automatically covering for omissions and reflecting possible user behaviour .. ‘unless entered, it’s the same’.

‘Most commonly used ratio’ could be confusing, not reporting the latest state of play... so suggest steer clear of that.

Cheers, John

Hi all,

We've just released an update to the diary summary - moving it to John's 'one line' model above. We've also added the total amount of QA insulin taken as corrective for High BG (or QC for short).

Still to do: The separate ratio and comments table.

Simon