Thursday, October 15, 2020

White Coat Adherence and Glucose Control

 Upcoming visits to a healthcare provider can cause a person to respond in different ways. The response can be involuntary or on purpose. Many patients’ blood pressure will rise or decline as a result of contact with a healthcare provider. This rise or fall in blood pressure is called the white coat syndrome. The change in blood pressure is involuntary. On the other hand, patients may purposely increase their adherence to their healthcare providers’ instructions just before the healthcare visit. This adherence is called white coat adherence (WCA). And WCA can lead to errors in treatment, including diabetes treatment.

WCA may be defined as “an increased adherence to treatment regimens directly before a visit with a healthcare provider.” And when WCA is present while treating diabetes, the situation can negatively affect the diabetes treatment. So, a study was done to determine how to lessen the possibility of a misinterpretation of Glucose Control  Monitoring data that might be caused by WCA.

It is known that up to 50% of patients who have chronic conditions will increase the adherence to medical guidelines just before and just after a healthcare provider visit. Patients will be more likely to take prescribed medications as directed and to follow treatment guidelines as directed two to three days before the visit and two to three days after the visit.

The above-mentioned study was an observational study, consisting of 276 patients. The investigators looked at patients between January 2013 and July 2018 who were using continuous or intermittent scanning glucose monitoring (rtCGM or iscCGM). And the investigators looked at CGM-data over various periods of time before and after a healthcare visit.

The investigators concluded that the WCA effect was especially present during the three days before a healthcare visit. And that a more accurate assessment of the patient’s diabetic condition can be made by looking at GCM-data two weeks before the scheduled healthcare meeting. Specifically, the investigators indicated that “based on [their] findings, analysis of CGM data, particularly in adult patients non-optimal diabetes control, should encompass a period of adequate length (i.e. a minimum of one-two weeks) before consultation to avoid misinterpretation due to WCA.”

The study just confirms the existence of WCA in diabetes treatment. But more than that, it offers guidance that can be put in place to minimize the associated misinterpretations of the CGM results.

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