Utilization of Information-Motivation-Behavioral Skills Model for Understanding Self-Monitoring OF Blood Glucose May be Useful for Overcoming Obstacles to Adherence

ORLANDO, FL (June 26, 2010) - An estimated 75 percent of adults with type 1 and type 2 diabetes say they believe they know what their blood sugar levels are without testing, according to data presented at the American Diabetes Association (ADA) 70th Scientific Sessions. These results are important to consider because self-monitoring with a blood glucose meter is essential for people with diabetes to obtain accurate blood sugar results that guide adjustments to meal planning, exercising and, most importantly for insulin users, accurately dosing their insulin. It is one of a number of key learnings from a study representing the first-ever use of the well-established information-motivation-behavioral skills (IMB) model of health behavior practice to understand barriers to self-monitoring of blood glucose (SMBG) among type 1 and type 2 diabetes patients.

Bayer Diabetes Care undertook the study to identify basic social and psychological factors that may be related to SMBG utilization in individuals with type 1 or type 2 diabetes and to better understand the reasons why some people have difficulty adhering to SMBG as recommended by their health care providers. Another objective of the study was to determine whether the IMB model, which has been applied effectively in several health behavior domains, may be effective in helping to understand and promote adherence to SMBG. The study was conducted by a co-developer of the IMB model, Dr. William Fisher, distinguished university professor in the Department of Psychology and the Department of Obstetrics and Gynecology at the University of Western Ontario in London, Canada.

The study findings revealed substantial information gaps, motivational obstacles and behavioral skills limitations that stand in the way of adherence to SMBG. Additionally, they suggest that an IMB skills model for understanding SMBG may be conceptually and empirically worthwhile and may provide a basis for supportive educational and clinical interventions to assist individuals with diabetes to adhere to SMBG recommendations.

“There is a considerable amount of medical literature about adherence in diabetes, and a wide range of interventions have been shown to have a positive effect on knowledge, frequency and accuracy of SMBG. Maintaining change in SMBG over time has been variable, however, and may be dependent upon regular reinforcement. What’s been lacking is a well-integrated behavioral science model of factors that influence SMBG adherence,” said Dr. Fisher. “We are gratified to see that the IMB for understanding and promoting health behavior change has worked well in a number of areas, including the prediction and promotion of safer sexual behavior, medication adherence, and other areas, providing evidence of utility in understanding SMBG in diabetes.”

According to the IMB model, information about SMBG that is directly translatable into adherence and appropriate glycemic control based on blood sugar results, motivation to act on this information, and behavioral skills for acting effectively are the fundamental determinants of SMBG adherence. Well-informed and well-motivated individuals will apply their behavioral skills to affect adherence to SMBG over the long run. Health outcomes of SMBG form a feedback loop that can strengthen or weaken SMBG information, motivation and behavioral skills, and moderating factors in an individual’s environment-such as competing demands from family and work-may also influence a person’s ability to engage in SMBG.

Dr. Fisher presented the study in a poster, “Understanding Self-Monitoring of Blood Glucose: An Information-Motivation-Behavioral Skills Analysis” at the ADA meeting. The poster was also highlighted during the ADA’s first ever guided audio poster tour - a new and innovative session added this year.

Additional Findings

A substantial number of individuals in the analysis reported information deficits with respect to SMBG. In a research sample of 416 adults with type 1 or type 2 diabetes, 46% and 53%, respectively, did not know that they should test after meals, and 21% and 40% did not know how to look for patterns in blood sugar readings. Further, as noted above, 75% say they don’t need to test because they believe they can gauge what their blood sugar levels are without testing.

Motivational obstacles to testing reported by adults with type 1 and type 2 included reports that testing constantly reminds them that they have diabetes (45% and 53%, respectively), is painful (34% and 35%), frustrating (26% and 25%) and time consuming (25% and 25%).

Behavioral skill limitations reported include difficulty testing without others knowing they are testing (29% and 20% for type 1 and type 2, respectively), difficulty downloading information from their blood sugar meter (27%, 24%), difficulty testing without too much pain (21% and 22%) and difficulty remembering to test (17% and 27%).

Importantly, findings from this research show a significant relationship between the presence of SMBG information gaps, SMBG motivational obstacles and SMBG behavioral skills limitations with reported frequency of SMBG for individuals with type 1 and type 2 diabetes.

“SMBG is increasingly seen as a behavioral tool in the management of diabetes,” said Dr. David Simmons, chief medical officer for Bayer Diabetes Care. “Bayer Diabetes Care was interested in determining whether the IMB model was appropriate to evaluate SMBG adherence in patients with diabetes. The depth of understanding of information gaps, motivational obstacles and behavioral skills limitations has helped us identify areas of patient education, professional education and development to improve products and services that Bayer can provide to customers.”

Study Design

The current research applied the IMB skills model of health behavior to identify correlations of frequency and adherence to recommended frequency of SMBG in a sample of 426 adults with type 1 and type 2 diabetes (type 1=208 and type 2=218).  Participants were enrolled in the Chronic Illness Panel of Harris Interactive and completed the survey online. Thirty-five SMBG information questions were rated on a 5-point like scale. Twenty-five SMBG motivation items were queried on 5-point and 7-point scales, and 34 SMBG behavioral skills items were rated on a 5-point scale. This was a cross-sectional study, which is a study done at one point in time, not over the course of time, and can measure the distribution and current relationships of characteristics of interest in a defined population.

Respondents who indicated strong disagreement, disagreement or neutral responses to correct information, or strong agreement, agreement or neutral responses to incorrect SMBG information were considered “uninformed.” Motivational items evaluating attitudes to personal performance of SMBG were assessed on a 5-point or 7-point scale and respondents on the negative side of the scale were coded as unmotivated.  On the SMBG behavioral skills scales, those who responded on the very difficult or difficult side of the scale were coded as unskilled.

Correlational analyses were conducted to assess the relationship between SMBG information, motivation and behavioral skills with average testing frequency. In both type 1 and type 2 diabetes, all three correlated with testing frequency, with stronger correlations seen in the type 1 population.

Significant greater limitations, with respect to SMBG information and SMBG motivation (p<0.05), were reported among individuals with type 2 compared to type 1 diabetes. Item selection procedures that resulted in formation of internally consistent scales assessing the SMBG IMB were reported (alphas >0.80), and the pattern of significant relationships among SMBG IMB and frequency of SMBG in the samples of individuals with type 1 and type 2 diabetes were reported as well.

About Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin. Approximately 23.6 million children and adults in the United States have diabetes, which puts them at risk for developing serious health complications over time, such as heart disease, kidney disease, blindness and stroke.[1] Type 1 diabetes, also called juvenile diabetes, is usually diagnosed in children and young adults. In persons with type 1 diabetes, the body makes little or no insulin, which may result in many complications if glucose levels are not controlled.[2] Type 2 diabetes is usually diagnosed in adults, although increasingly, children are being diagnosed with this disease. Type 2 is associated with obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity and race/ethnicity.[3]  An estimated 30% of people with diabetes require insulin to manage their disease. Those who require insulin must closely monitor their blood sugar with a blood glucose meter to plan their meals, exercise regimens and insulin dosage.

Bayer Diabetes Care

Bayer Diabetes Care is a worldwide leader in diabetes care, supporting customers in 100 countries and, for more than 40 years, has led the way in diabetes care product innovation. Today, Bayer Diabetes Care offers an unparalleled choice in diabetes management systems and comprehensive support including education, tools and resources designed to simplify life with diabetes. Bayer Diabetes Care is a business of the Bayer HealthCare LLC, Medical Care Division and has its global headquarters located in Tarrytown, New York. Find more information at www.simplewins.com.

Bayer HealthCare

The Bayer Group is a global enterprise with core competencies in the fields of health care, nutrition and high-tech materials. Bayer HealthCare, a subsidiary of Bayer AG, is one of the world’s leading, innovative companies in the healthcare and medical products industry and is based in Leverkusen, Germany. The company combines the global activities of the Animal Health, Consumer Care, Medical Care and Pharmaceuticals divisions. The pharmaceuticals business operates under the name Bayer Schering Pharma. Bayer HealthCare’s aim is to discover and manufacture products that will improve human and animal health worldwide. Find more information at www.bayerhealthcare.com.

Diabetes Living Today® radio program, provides listeners with education, inspiration and motivation to live healthy and well with diabetes. Whether you have diabetes or know someone who does Diabetes Living Today® radio program offers experience, insight, education and tips to manage life with diabetes. Through interviews, including “World Class” Research Scientist, physicians and people living with diabetes, living well tips and questions from the listening audience, host Kitty Castellini and Endocrinologist Dr. Joseph J. Fallon, Jr. are there every step of the way to offer guidance, advice, and most of all, support.

This week Kitty and Dr. Fallon will interview Dr. James R. Gavin, clinical professor of medicine at Emory University School of Medicine and Luc Vierstraete, Senior Vice President and General Manager of Roche Diabetes Care of North America.  

Listeners are invited to call in with their questions and comments. Sunday afternoon 3:00PM ~ 4:00PM (EST) New World Radio 1540 am ~ WNWR.Com, streaming live on the web at www.wnwr.com Call In: NJ: 877-667-WNWR, PA:  610-667-WNWR.  Listen on your cell phone:  215-554-6101

About the DCP

The Diabetes Care Project is a coalition of patient advocates and health partners whose goal is to educate patients, caregivers, health care providers and policymakers on the value of developing personalized management plans for diabetes patients in an effort to improve each patient’s health outcomes and lower costs for the entire health system. Roche Diagnostics and the National Minority Quality Forum are founding partners of the Diabetes Care Project, which is supported by the American Association of Diabetes Educators and the Alliance for Aging Research. Project partners are committed to improving patient outcomes and advancing diabetes care and management.

About Dr. Gavin

James R. Gavin III, MD, PhD, is clinical professor of medicine at Emory University School of Medicine in Atlanta, Georgia, and Clinical Professor of Medicine at the Indiana University School of Medicine, Indianapolis, Indiana. He serves as CEO and Chief Medical Officer of Healing Our Village, Inc., He served as president and CEO of MicroIslet, Inc., San Diego, California, maintaining an office base in Atlanta, was president of the Morehouse School of Medicine; served as senior scientific officer at the Howard Hughes Medical Institute (HHMI) and as director of the HHMI-National Institutes of Health Research Scholars Program. He is a past president of the ADA and was voted Clinician of the Year in Diabetes by the ADA in 1991. He was voted a Living Legend in Diabetes in 2009 by the American Association of Diabetes Educators. He has served on many advisory boards and on the editorial boards of the American Journal of Physiology and the American Journal of Medical Sciences. He is on the board of trustees for Emory University, Livingstone College, and is a trustee emeritus of the Robert Wood Johnson Foundation. Dr Gavin is also chairman emeritus of the National Diabetes Education Program and a past member of the Board of Scientific Councilors for the Intramural Research Program of NIDDK at the NIH.”

Photo Above:  Dr. James R. Gavin, MD, PhD.

About Luc Vierstraete

Luc Vierstraete was appointed Senior Vice President and General Manager of Roche Diabetes Care North America in January 2007.  The Diabetes Care business unit provides innovative blood glucose monitoring systems, services and programs to consumers, medical professionals, hospitals and retailers. Luc oversees the business, operational and portfolio excellence of the company’s ACCU-CHEK^® brand of products. Vierstraete joined Roche in 1987 at Group Headquarters in Basel, Switzerland. From 1987 through 2006 he held key positions as General Manager of Roche Pharmaceuticals in Norway, Thailand and Belgium and General Manager of Roche Diagnostics in Italy. Prior to joining Roche, Vierstraete held sales and marketing positions at Schering-Plough in Belgium, Switzerland, Austria and Eastern Europe. Vierstraete earned his master’s degree in European economics at the University of Brussels in Belgium and his master’s degree in economics and commercial sciences at the Business University in Vienna, Austria.

Photo Above:  Mr. Luc Vierstraete

Listen to The Latest Broadcast of Diabetes Living Today®

June 19, 2010 ~ Dr. Louis C. Hanel, Endocrinologist

Diabetes Living Today® radio program, provides listeners with education, inspiration and motivation to live healthy and well with diabetes. Whether you have diabetes or know someone who does Diabetes Living Today® radio program offers experience, insight, education and tips to manage life with diabetes. Through interviews, including “World Class” Research Scientist, physicians and people living with diabetes, living well tips and questions from the listening audience, host Kitty Castellini and Endocrinologist Dr. Joseph J. Fallon, Jr. are there every step of the way to offer guidance, advice, and most of all, support.

This week Kitty and Dr. Fallon will interview Dr. Donna H. Ryan.  Listener’s are invited to call in with their questions and comments.  Tuesday Evening 8:00 pm ~ 9:00 pm (EST) Cruisin 92.1 FM~WVLT, streaming live on the web at www.wvlt.com  Call In:  856-696-0092.

Donna H. Ryan, MD, FACP

Professor

Associate Executive Director

Clinical Research

Pennington Biomedical Research Center

Baton Rouge, Louisiana

Donna H. Ryan, MD, FACP, is a Professor and Associate Executive Director for Clinical Research at the Pennington Biomedical Research Center in Baton Rouge, LA. She has been actively engaged in obesity and nutrition research for the last 20 years.

Dr. Ryan is the President-Elect of the Obesity Society, an organization of more than 2000 American scientists. She is the Co-Chair of the panel that is currently revising the National Institutes of Health (NIH)-sponsored Guidelines for the Evaluation and Management of Overweight and Obesity, so-called “Obesity II.”

Dr. Ryan’s research interests include many aspects of obesity management and prevention including the following:

• Obesity pharmacotherapy
• Evaluation of diets of different macronutrient composition for weight loss
• Practical or pragmatic clinical trials to evaluate primary care approaches to obesity management
• Translational research engaging third-party payers in obesity intervention

Dr. Ryan has received funding from the Department of Defense to oversee a Military Nutrition Research project in which she collaborates with the US Army Research Institute for Environmental Medicine’s Military Nutrition Division. She is Co-Primary Investigator for the NIH-funded Clinical Nutrition Research Center at Pennington and Co-Primary Investigator for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)-sponsored Look AHEAD study that addresses weight loss in persons with type 2 diabetes. Her most recent project is the submission, as Primary Investigator, of a state-wide Clinical Translational Science Award, which will encompass nine Louisiana research institutions.

Photo Above:  Dr. Donna Ryan

Listen to The Latest Broadcast of Diabetes Living Today®

May 16, 2010 ~ T2D: A Devastating Cardiovascular Disease with Dr. Robert J. Chilton

Diabetes Living Today® radio program, provides listeners with education, inspiration and motivation to live healthy and well with diabetes. Whether you have diabetes or know someone who does Diabetes Living Today® radio program offers experience, insight, education and tips to manage life with diabetes. Through interviews, including “World Class” Research Scientist, physicians and people living with diabetes, living well tips and questions from the listening audience, host Kitty Castellini and Endocrinologist Dr. Joseph J. Fallon, Jr. are there every step of the way to offer guidance, advice, and most of all, support.

This week Kitty and Dr. Fallon will interview Dr. Jeffrey L. Miller from Jefferson Medical College.  Listeners are invited to call in with their questions and comments. Sunday afternoon 3:00PM ~ 4:00PM (EST) New World Radio 1540 am ~ WNWR.Com, streaming live on the web at www.wnwr.com Call In: NJ: 877-667-WNWR, PA:  610-667-WNWR.  Listen on your cell phone:  215-554-6101

Jeffrey Lynn Miller, MD

Jeffrey Lynn Miller, MD is Clinical Professor and Director of Clinical Endocrinology and Diabetes with the Division of Endocrinology and Metabolism, Department of Medicine, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, PA. Dr Miller’s current research involves the Cardiovascular Implications of Insulin Resistance Syndrome and is involved in numerous Diabetes Clinical Pharmaceutical Trials.

Dr Miller received his MB, BCh from the University of Witwatersrand, South Africa in 1974.  He then interned at the Department of Medicine, Johannesburg General Hospital at the University and was a resident in the Department of Pathology, Groote Schuur Hospital and University of Cape Town, South Africa.  He then completed Internal Medicine residency followed by Endocrine fellowship at the same institution.He is boarded in both Internal Medicine and Endocrinology.

Among his society memberships are the American Association of Endocrinologists, American Diabetes Association, and the American Endocrine Society. Dr Miller was on the list of top doctors cited in Philadelphia Magazine in 1999 and top doctors for Women in the 2000 issue. He also has been cited in Who’s Who in the World, 5^th edition. Dr Miller has been published extensively throughout his career in such journals as Clinical Endocrinology, American Journal of Medicine, and South African Medical Journal.

 Photo Above:  Dr. Jeffrey L. Miller

Diabetes Living Today® radio program, provides listeners with education, inspiration and motivation to live healthy and well with diabetes. Whether you have diabetes or know someone who does Diabetes Living Today® radio program offers experience, insight, education and tips to manage life with diabetes. Through interviews, including “World Class” Research Scientist, physicians and people living with diabetes, living well tips and questions from the listening audience, host Kitty Castellini and Endocrinologist Dr. Joseph J. Fallon, Jr. are there every step of the way to offer guidance, advice, and most of all, support.

This week Kitty and Dr. Fallon will interview Dr. Matthew Wintle, MRCP from Amylin Pharmaceuticals, Inc.   Listeners are invited to call in with their questions and comments. Sunday afternoon 3:00PM ~ 4:00PM (EST) New World Radio 1540 am ~ WNWR.Com, streaming live on the web at www.wnwr.com Call In: NJ: 877-667-WNWR, PA:  610-667-WNWR.  Listen on your cell phone:  215-554-6101

Dr. Matthew Wintle, MRCP (UK)

Director, Research & Development Strategic Relations

Amylin Pharmaceuticals Inc.

Dr. Wintle graduated from University of Wales College of Medicine in 1997 and gained early clinical experience in clinical pharmacology & toxicology. Combining a career as an international rugby player with training in cardiology, respiratory, general, intensive and acute care medicine he was elected to the Royal College of Physicians (UK) in 2001. He joined Amylin Pharmaceuticals in 2002 providing physician oversight to all phases of Amylin’s clinical development program with responsibility for drug safety analyses and regulatory submissions. Following the FDA approval of two first-in-class diabetes therapies, BYETTA (exenatide) and SYMLIN (pramlintide) in 2005 he joined Amylin Medical Affairs as Director of Medical Programmes to support their global launch. He established Health Outcomes research at Amylin in 2005, chaired the Amylin-Lilly data analysis team and led many aspects of their late-stage research. His current responsibilities include providing strategic input to Amylin’s Research & Development programs with a lead role for their cardiometabolic research strategy and external communications with health care professionals, managed care, government, and business groups.

Photo Above:  Dr. Matthew Wintle, MRCP