White coat adherence effect on glucose control in adult individuals with diabetes

Background: White coat adherence (WCA) is defined as an increased adherence to treatment regimens directly before a visit with a healthcare provider. Little is known on the effect of WCA on glucose control in adult patients with diabetes mellitus.

Methods: The present study is based on 618 CGM-observations of 276 patients with diabetes treated between January 2013 and July 2018. The analysis compares data from the 3 days prior to a visit (p1) with the preceding 25 days (p2).

Results: Sensor use was higher during p1 than p2 (92.8 ± 7.3% vs 88.8 ± 7.5%; p < 0.001). Mean glucose [MG] and coefficient of variation [CV] were lower in p1 compared to p2 (MG 163.9 ± 39.2 mg/dL vs 166.9 ± 35.7 mg/dL, p = 0.001; CV 33.5 ± 8.4% vs 36.0 ± 7.0%, p < 0.001; respectively). Time in range (70-180 mg/dL) was higher in p1 than p2 (61.4 ± 21.2% vs 60.0 ± 18.4%, p = 0.002). Sensitivity-analysis showed that WCA effect was mainly detected in patients with HbA_1c > 7% [53 mmol/mol].

Conclusion: This study reveals a WCA effect on pre-visit glucose control in adult patients with diabetes. The effect was most pronounced in patients with moderate to poor glycemic control. In these patients, analysis of CGM data should encompass a minimum of 1 to 2 weeks prior to a consultation.