Research by diabetes nurse prompts changes to Self-monitoring Guidelines

Diabetes patients who monitor their own blood-glucose levels using a blood-glucose meter and a drop of blood should wash their hands with soap and water before carrying out the procedure. This ensures that the first drop of blood will give an accurate reading. Even if their fingers are not visibly dirty, or if they have touched glucose (sugar), the first drop of blood should be wiped away and the second drop used to give an accurate blood glucose reading if they are unable to wash their hands. These are findings from a study conducted by diabetes nurse Hanneke Hortensius from Isala Klinieken in Zwolle. Her research has prompted an amendment to the Dutch Guidelines for Self-monitoring. Hortensius will be awarded a PhD for her research by the University of Groningen on 15 May 2013, making her the first diabetes nurse in the Netherlands to be awarded a PhD.

An estimated 250,000 people in the Netherlands are treated with insulin. Self-monitoring is a vital instrument for this group of patients. The aim of self-monitoring is to regulate medication in order to reduce the risk of micro and macrovascular complications. Most of these people will have to monitor their own blood glucose levels for the rest of their lives, some of them on a daily basis. Hortensius is one of the first researchers to conduct a scientific study of the important practical aspects of self-monitoring among this category of patients. Her findings have led to practical recommendations for self-monitoring.

Drops of blood

In one of her tests, Hortensius examined which particular drop of blood would give the most accurate blood glucose reading in different situations. She came up with three recommendations. If the patient can wash his/her hands with soap and water, it is best to use the first drop of blood for monitoring blood glucose. If the patient’s hands are not visibly dirty or if they have touched glucose, but he/she is unable to wash his/her hands, it is better to wipe away the first drop of blood and use the second. If the patient’s hands are visibly dirty or have touched glucose and he/she is unable to wash them, she concludes that a reliable blood glucose reading is simply not possible. In this latter situation, Hortensius advises against self-monitoring. Her conclusions have prompted an amendment to the multidisciplinary Guidelines for Self-monitoring.

Personal points for special attention

People do not always perceive self-monitoring as a useful instrument. On the contrary, some people consider it to be a nuisance and a permanent reminder of their diabetes. Based on the results of her research, Hortensius devised a questionnaire asking people about how they perceive self-monitoring. Up until now, there has never been a structural way of asking patients how they feel about self-monitoring. Hortensius expects that discussing their perception of this procedure will give them a better understanding of self-monitoring, thereby helping them to regulate their glucose levels and improve their quality of life.

Curriculum Vitae

Hanneke Hortensius (Harderwijk, 1964) is a diabetes nurse in the Isala Klinieken in Zwolle. She conducted her research in the Diabetes Knowledge Centre of the Isala Klinieken. Her thesis is entitled ‘Self monitoring of blood glucose in insulin-treated patients with diabetes’. Once she has been awarded her PhD, she will start work as a trainee Nurse Practitioner in Het Zonnehuis nursing home in Vlaardingen.