Self-monitoring of blood glucose in Type 2 diabetes: cross-sectional analyses in 1993, 1999 and 2009

Aim: To characterize the numbers of reagent strips dispensed for self-monitoring of blood glucose to patients with Type 2 diabetes in Tayside, Scotland, in 1993, 1999 and 2009. Methods: A diabetes clinical information system in Tayside, record-linked to electronic dispensed prescribing records, was used to collate all dispensed prescribing records for three cross-sectional samples of patients with Type 2 diabetes in 1993 (n = 5728), 1999 (n = 8109) and at 1 January 2009 (n = 16450). The numbers of reagent strips dispensed during the relevant calendar year were calculated and patients stratified by treatment. We also explored whether age, sex or material and social deprivation were associated with whether a patient received strips. Results: Proportions of people who received self-monitoring reagent strips increased from 15.5% in 1993, to 24.2% in 1999 to 29.8% in 2009, as did numbers of strips dispensed. While the proportion of diet-treated patients who received reagent strips was still very low in 2009 (5.6%), the proportion among those treated with oral agents tripled from 9.4 to 27.4% between 1993 and 2009. Over 90% of patients treated with insulin received reagent strips and, among non-insulin-treated patients, this was more common among women, younger people and less deprived groups. Conclusions: The numbers of reagent strips dispensed for self-monitoring of blood glucose has increased and almost all insulin-treated patients receive strips. While few diet-treated patients receive strips, they are more extensively dispensed to those treated with oral agents. Given that self-monitoring of blood glucose is no longer routinely recommended in non-insulin treated patients, strategies to reduce unnecessary dispensing of reagent strips are needed

A physical activity intervention in a Bingo club: Significance of the setting

Objective:  A Bingo club was selected for the design and delivery of a health intervention (Well!Bingo) in order to engage with older women living in areas areas of socio-economic disadvantage. In the light of our experience, we discuss the significance of the setting in relation to a typology of health promotion settings.  Design and Setting:  The Well!Bingo physical activity intervention was piloted in a Bingo club in Scotland.  Methods:  In a pilot feasibility study, women were recruited face-to-face at a Bingo club over two weeks. The 12-week intervention consisted of three different structured exercise sessions per week, followed by refreshments, with trained instructors delivering a schedule of simple pre-defined health messages. Participants completed a baseline questionnaire, and in-depth qualitative interviews were carried out with participants and instructors post-intervention. For this paper, using the framework method, we retrieved and analysed the data coded as relating to the setting.  Results:  Eighteen women (55-92 years) took part in intervention sessions. Half lived in areas of socio-economic deprivation. Practical and social familiarity with the setting (a sense of belonging and being with people like themselves) encouraged them to take part, and implicit features of the setting may have enhanced recruitment and effectiveness.  Discussion:  In settings-based health promotion, a Bingo club could be seen as a ‘passive' setting, simply facilitating access to a target population. It cannot be an ‘active setting', because health promotion will never be a core activity and features cannot be drawn upon to influence change. However, calling it a passive setting overlooks the importance of characteristics that may enhance recruitment and effectiveness. This highlights the need to extend current concepts of ‘passive' health promotion settings

Self-monitoring of blood glucose in type 2 diabetes: Patients' perceptions of 'high' readings

Among 207 non-insulin using patients with type 2 diabetes in Tayside, Scotland, who self-monitored blood glucsoe, we present evidence that many are tolerant of higher blood glucsoe levels that are clinically advisable; this may explain the lack of empirical evidence for the clinical benefits of self-monitoring in this group

Self-monitoring among non-insulin treated patients with type 2 diabetes mellitus: Patients' behavioural responses to readings and associations with glycaemic control

Aim: To investigate self-monitoring of blood glucose (SMBG) behaviour among non-insulin treated patients with type 2 diabetes mellitus, and to evaluate associations with glycaemic control. Methods: Eligible patients in 23 GP practices in Tayside, Scotland, were identified (18-75 years, no insulin treatment, SMBG reagent strips dispensed in 2009). Consenting patients were administered questionnaires addressing SMBG behavior: these primary data were record-linked to clinical data (including HbA1c) from a validated population-based diabetes clinical information system, then anonymised. Results: Among 629 eligible patients, 207 were interviewed and analysed. Mean SMBG reagent strips dispensed in 12 months was 268. Eighty (38.8%) patients took no action in response to perceived high test results, or simply checked later. Most (61.3%) did not know what action to take. 126 (61.2%) patients took action, including dietary (n=101), physical activity (n=12) or medication (n=10) changes, or making a HCP appointment (n=12). High score on a Diabetes Knowledge Test was a statistically significant predictor of taking action (odds ratio: 2.07). However, neither taking action nor increased SMBG frequency were associated with improved glycaemic control. Conclusions: Responding to SMBG test results and increased testing frequency were not associated with improved glycaemic control in the short-term. There is a lack of knowledge surrounding SMBG in non-insulin treated patients

Accessing and engaging women from socio-economically disadvantaged areas: a participatory approach to the design of a public health intervention for delivery in a Bingo club

Background Our aim was to use participatory methods to investigate the feasibility and acceptability of using Bingo clubs for the design and delivery of an evidence-based physical activity and/or healthy eating intervention to socio-economically disadvantaged women. This paper describes the participatory process that has resulted in a physical activity intervention for women aged >55years, ready for pilot-testing in a Bingo club setting. Methods Studies using different quantitative and qualitative approaches were conducted among customers and staff of a Bingo club in a city of 85,000 inhabitants in central Scotland. These were designed to take the views of different stakeholders into account, with a view to enhancing uptake, engagement and effectiveness with any proposed intervention. Results Sixteen relevant studies were identified in a literature review that generated ideas for intervention components. A questionnaire completed by 151 women in the Bingo club showed that almost half (47%) aged >55years were not meeting physical activity guidelines; evidence backed up by accelerometer data from 29 women. Discussions in six focus groups attended by 27 club members revealed different but overlapping motivations for attending the Bingo club (social benefits) and playing Bingo (cognitive benefits). There was some scepticism as to whether the Bingo club was an appropriate setting for an intervention, and a dietary intervention was not favoured. It was clear that any planned intervention needed to utilise the social motivation and habitual nature of attendance at the Bingo club, without taking women away from Bingo games. These results were taken forward to a 5-h long participative workshop with 27 stakeholders (including 19 Bingo players). Intervention design (form and content) was then finalised during two round table research team meetings. Conclusions It was possible to access and engage with women living in areas of socio-economic disadvantage through a Bingo club setting. A physical activity intervention for women >55years is realistic for recruitment, will address the needs of potential recipients in the Bingo club, appears to be feasible and acceptable to club members and staff, and has been designed with their input. A pilot study is underway, investigating recruitment, retention and feasibility of delivery

How active are women who play bingo: a cross-sectional study from the Well!Bingo project

BackgroundThe benefits of physical activity are well established, yet large numbers of people are not sufficiently active to gain health benefits. Certain population groups are less physically active than others, including older women from areas of high economic deprivation. The Well!Bingo project was established with the aim of engaging such women in the development of a health promotion intervention in a bingo club. This paper reports on the assessment of health status, physical activity and sedentary behaviour of women attending a bingo club in central Scotland, UK as part of the Well!Bingo project.MethodsWomen attending the bingo club were invited to provide information on demographic characteristics, and self-reported physical activity and sedentary behaviour via a self-complete questionnaire as part of a cross-sectional study (n = 151). A sub-sample (n = 29) wore an accelerometer for an average of 5.7 ± 1.4 days. Differences between younger (under 60 years) and older adults (60 years and over) were assessed using a chi-square test for categorical data and the independent samples t-test was used to assess continuous data (p < 0.05).ResultsThe mean age was 56.5 ± 17.7 years, with 57% living in areas of high deprivation (Scottish Index of Multiple Deprivation quintile one and two). Sixty-three percent of women (n = 87) reported they were meeting physical activity guidelines. However, objective accelerometer data showed that, on average, only 18.1 ± 17.3 min a day were spent in moderate to vigorous physical activity. Most accelerometer wear time was spent sedentary (9.6 ± 1.7 h). For both self-report and accelerometer data, older women were significantly less active and more sedentary than younger women. On average, older women spent 1.8 h more than younger women in sedentary activities per day, and took part in 21 min less moderate to vigorous physical activity (9.4 mins per day).ConclusionThe findings of this study suggest that bingo clubs are settings that attract women from areas of high deprivation and older women in bingo clubs in particular would benefit from interventions to target their physical activity and sedentary behaviour. Bingo clubs may therefore be potential intervention settings in which to influence these behaviours

Enhanced Nutrition Communications - Mailing the Best of Food Labels

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Observation and assessment of the nutritional quality of ‘out of school’ foods popular with secondary school pupils at lunchtime

Background: The contemporary Scottish diet is unhealthy and a risk factor for poor health outcomes including obesity. Over a third of Scottish children are at risk of being overweight or obese, and there have been calls to strengthen the evidence base on the role of the food retail environment around schools in influencing the consumption of unhealthy foods. Methods: We examined the food retail environment around five secondary schools in Glasgow city, Scotland. Trained fieldworkers observed the food purchasing behaviour of school pupils in local shops. Samples of the most popular foods were subsequently purchased by the research team and assessed for nutritional content, including energy, total and saturated fat, and salt. This was compared with the nutrient standards for school lunches established by the Scottish Government. Results: There was marked variation in the number of outlets identified within a 10 min walk from each school, ranging from five in the area with the lowest number of outlets to thirty in the area with the highest number of outlets. Outlets identified were heterogeneous and included fish and chip shops, kebab shops, convenience stores, newsagents, bakeries, mobile catering units, cafés, pizzerias, sandwich shops and supermarkets. Lunchtime offers and other marketing strategies targeting school pupils were observed at most outlets. Nutritional analysis of the 45 savoury food items purchased was conducted by laboratory staff. Of the foods analysed, 49% of the samples exceeded recommended calorie intake, 58% exceeded total fat recommendations and 64% exceeded saturated fat recommendations, 42% exceeded recommended salt levels. Over 80% of the 45 food items sampled did not comply with one of more of the nutrient standards for fat, saturated fat and salt. Meal deals and promotions of unhealthy foods aimed at pupils were widely available. Conclusions: The majority of pupils purchased unhealthy convenience food of poor nutritional value at lunchtime in local shops around their school. Further effort is required to implement regulatory levers such as taxation on unhealthy foods, restriction on the concentration of outlets selling unhealthy foods as well as the development of partnerships and additional measures within and beyond schools to promote healthy foods