Facilitators and Barriers to Self-Monitoring of Blood Glucose (SMBG) in Diabetic Patients
Journal of Pharmaceutical Research International,
Page 119-127
DOI:
10.9734/jpri/2020/v32i2530830
Abstract
Objective: To determine factors that facilitate and are barriers to self-monitoring of blood glucose in type 2 diabetic patients visiting family medicine clinics at a tertiary care teaching hospital Karachi Pakistan.
Methods: Approximately 255 patients were consecutively recruited from the clinics during April 2018 to May 2019 at Family Medicine outpatient clinics at the Aga Khan University Hospital. Data on socio-demographic status, facilitators and barriers to SMBG were extracted through a questionnaire, after obtaining an informed written consent. Data was entered and analyzed in SPSS version 19.
Results: Among study participants 47.5% were above 50 years and 51.4% were males. About 30.2% of the participants were practicing SMBG at least once a month and 26% were practicing it daily. Fear of complications was the biggest facilitator (80.1%) and being expensive (51.4%) was barrier for SMBG. Over half of the SMBG practicing participants (59.7%) were diagnosed with diabetes for more than 05 years (p: 0.63).
Conclusion: Assessment of blood glucose is a critical component of diabetes treatment and management. It can motivate patients to become active participants in their own care. Health care providers should communicate and educate the patients about the advantages of SMBG.
Keywords:
- T2DM
- self-monitoring blood glucose (SMBG)
- facilitators to SMBG
- barriers of SMBG.
How to Cite
Brohi, A. H., Hakim, A., Wassan, S. M., Soomro, A. M., Bhatti, W. S., Tunio, A. H., Kumar, A., Baloch, N., Malhani, W. A., Mangi, A. A., Alahmadi, Y. M., Baloch, K., Khan, M., & Arain, S. P. (2020). Facilitators and Barriers to Self-Monitoring of Blood Glucose (SMBG) in Diabetic Patients. Journal of Pharmaceutical Research International, 32(25), 119-127. https://doi.org/10.9734/jpri/2020/v32i2530830
References
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Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Research and Clinical Practice. 2017;128: 40-50.
Zimmet P, Alberti KG, Magliano DJ, Bennett PH. Diabetes mellitus statistics on prevalence and mortality: facts and fallacies. Nature Reviews Endocrinology. 2016;12(10):616.
Nanditha A, Ma RC, Ramachandran A, Snehalatha C, Chan JC, Chia KS, et al. Diabetes in Asia and the Pacific: implications for the global epidemic. Diabetes Care. 2016;39(3):472-85.
Akhtar S, Khan Z, Rafiq M, Khan A. Prevalence of Type II diabetes in District Dir Lower in Pakistan. Pakistan journal of medical sciences. 2016;32(3):622.
Harashima S-i, Nishimura A, Ikeda K, Wang Y, Liu Y, Inagaki N. Once Daily Self-Monitoring of Blood Glucose (SMBG) improves Glycemic control in Oral Hypoglycemic Agents (OHA)–Treated Diabetes: SMBG-OHA Follow-Up Study. Journal of Diabetes Science and Technology. 2016;10(2):378-82.
Rhee E-J. Diabetes in Asians. Endocrinology and Metabolism. 2015;30(3):263-9.
Ranasinghe P, Mathangasinghe Y, Jayawardena R, Hills A, Misra A. Prevalence and trends of metabolic syndrome among adults in the asia-pacific region: a systematic review. BMC public health. 2017;17(1):101.
Control TD, Group CDR. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney International. 1995;47(6):1703-20.
Young LA, Buse JB, Weaver MA, Vu MB, Mitchell CM, Blakeney T, et al. Glucose self-monitoring in non–insulin- treated patients with type 2 diabetes in primary care settings: a randomized trial. JAMA Internal Medicine. 2017;177(7):920-9.
Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non- masked, randomised controlled trial. The Lancet. 2016;388(10057):2254-63.
Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline J-P, Rayman G. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Therapy. 2017;8(1):55-73.
Heinemann L, Deiss D, Siegmund T, Schlüter S, Naudorf M, von Sengbusch S, et al. Practical recommendations for glucose measurement, glucose monitoring and glucose control in patients with type 1 or type 2 diabetes in Germany. Experimental and Clinical Endocrinology & Diabetes. 2018;126(07):411-28.
Charity KW, Kumar AM, Hinderaker SG, Chinnakali P, Pastakia SD, Kamano J. Do diabetes mellitus patients adhere to self-monitoring of blood glucose (SMBG) and is this associated with glycemic control? Experiences from a SMBG program in western Kenya. Diabetes Research and Clinical Practice. 2016;112:37-43.
Wong JC, Foster NC, Maahs DM, Raghinaru D, Bergenstal RM, Ahmann AJ, et al. Response to Comment on Wong et al. Real-time continuous glucose monitoring among participants in the T1D exchange clinic registry. Diabetes Care. 2014;37:2702–2709. Diabetes Care. 2015;38(4):e61-e.
Lim S, Kang SM, Kim KM, Moon JH, Choi SH, Hwang H, et al. Multifactorial intervention in diabetes care using real-time monitoring and tailored feedback in type 2 diabetes. Acta Diabetologica. 2016;53(2):189-98.
Gao L, Ji L, Su Q, Feng B, Shan Z, Hu R, et al. Impact of structured self-monitoring of blood glucose on the quality of life of insulin-treated Chinese patients with type 2 diabetes-mellitus: Results from the COMPASS study. Diabetes Research and Clinical Practice. 2016;112:88-93.
Ong WM, Chua SS, Ng CJ. Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study. Patient Preference and Adherence. 2014;8: 237.
Vidal MF, Jansà MM, Galindo MR, Penalba MM. Factors associated to adherence to blood glucose self-monitoring in patients with diabetes treated with insulin. The dapa study. Endocrinologia, Diabetes y Nutricion. 2018;65(2):99-106.
Havele SA, Pfoh ER, Yan C, Misra-Hebert AD, Le P, Rothberg MB. Physicians’ views of self-monitoring of blood glucose in patients with type 2 diabetes not on insulin. The Annals of Family Medicine. 2018;16(4):349-52.
Sham SYZ, Thambiah SC, Samsudin IN, Chuan NO, Wei YS, Razmin NI. Practice of Self-monitoring blood glucose among insulin-treated diabetic patients in hospital serdang. Malaysian Journal of Medicine and Health Sciences. 2016;12(2):38-44.
Manroa P, Krupa Doshi M. Self-monitoring of blood glucose: Advice for providers and patients. Cleveland Clinic Journal of Medicine. 2016;83(5):355.
Al-Sahouri A, Merrell J, Snelgrove S. Barriers to good glycemic control levels and adherence to diabetes management plan in adults with Type-2 diabetes in Jordan: a literature review. Patient Preference and Adherence. 2019;13:675.
Agesen RM, Kristensen PL, Beck-Nielsen H, Nørgaard K, Perrild H, Jensen T, et al. Effect of Insulin Analogs on Frequency of Non–Severe Hypoglycemia in Patients with Type 1 Diabetes Prone to Severe Hypoglycemia: Much Higher Rates Detected by Continuous Glucose Monitoring than by Self-Monitoring of Blood Glucose—The HypoAna Trial. Diabetes Technology & Therapeutics. 2018;20(3):247- 56.
Hermanns N, Ehrmann D, Kulzer B. Continuous glucose monitoring-based technologies in hypoglycaemia- prone patients with type 1 diabetes. The lancet Diabetes & endocrinology. 2019;7(6):419-21.
Krishnan V, Thirunavukkarasu J. Assessment of knowledge of self blood glucose monitoring and extent of self titration of anti-diabetic drugs among diabetes mellitus patients–a cross sectional, community based study. Journal of clinical and diagnostic research: JCDR. 2016;10(3):FC09.
Fidler C, Elmelund Christensen T, Gillard S. Hypoglycemia: an overview of fear of hypoglycemia, quality-of-life, and impact on costs. Journal of medical economics. 2011;14(5):646-55.
Byers D, Garth K, Manley D, Chlebowy D. Facilitators and barriers to Type 2 diabetes self-management among rural African American adults. Journal of Health Disparities Research and Practice. 2016;9(1):9.
Pamungkas R, Chamroonsawasdi K, Vatanasomboon P. A systematic review: family support integrated with diabetes self-management among uncontrolled type II diabetes mellitus patients. Behavioral Sciences. 2017;7(3):62.
Dogru A, Ovayolu N, Ovayolu O. The effect of motivational interview persons with diabetes on self- management and metabolic variables. JPMA. 2019;69(294).
Shahar S, Fakhruddin NNINM, Hui KJ, Suhaimi NFS, Zulkepli NYF, Roslan R, et al. Family support and self- motivation influence dietary compliance and glycaemic control among type 2 diabetes mellitus outpatients. Jurnal Sains Kesihatan Malaysia (Malaysian Journal of Health Sciences). 2016;14(2).
Xie Y, Agiro A, Bowman K, DeVries A. Lowering cost share may improve rates of home glucose monitoring among patients with diabetes using insulin. Journal of Managed Care & Specialty Pharmacy. 2017;23(8):884-91.
Klatman EL, Jenkins AJ, Ahmedani MY, Ogle GD. Blood glucose meters and test strips: global market and challenges to access in low-resource settings. The lancet Diabetes & Endocrinology. 2019; 7(2):150-60.
Ugwu ET, Orjioke CJ, Young EE. Self monitoring of blood glucose among patients with type 2 diabetes mellitus in eastern Nigeria: Need for multi-strategic interventions. Current Diabetes Reviews. 2018;14(2):175-81.
Khowaja LA, Khuwaja AK, Cosgrove P. Cost of diabetes care in out-patient clinics of Karachi, Pakistan. BMC health services research. 2007;7(1):189.
Walker IF, Garbe F, Wright J, Newell I, Athiraman N, Khan N, et al. The economic costs of cardiovascular disease, diabetes mellitus, and associated complications in South Asia: a systematic review. Value in Health Regional Issues. 2018;15:12-26.
Afroz A, Chowdhury HA, Shahjahan M, Hafez MA, Hassan MN, Ali L. Association of good glycemic control and cost of diabetes care: experience from a tertiary care hospital in Bangladesh. Diabetes Research and Clinical Practice. 2016;120:142-8.
Mohan V, Mapari JA, Karnad PD, Mann JS, Maheshwari VK. Reduced diabetes mellitus-related comorbidities by regular self-monitoring of blood glucose: Economic and quality of life implications. Indian Journal of Endocrinology and Metabolism. 2018;22(4):461.
Morera J. Insulin Injection and Blood Glucose Meter Systems. Handbook of Diabetes Technology: Springer. 2019;3-21.
Shlomowitz A, Feher MD. Anxiety associated with self monitoring of capillary blood glucose. British Journal of Diabetes. 2014;14(2):60-3.
Mehmet S, Hussey C, Ibrahim S. Patients’ perceptions of injecting insulin and self‐monitoring of blood glucose in the presence of others. Practical Diabetes. 2015;32(2):59- 63.
Laranjo L, Neves AL, Costa A, Ribeiro RT, Couto L, Sá AB. Facilitators, barriers and expectations in the self- management of type 2 diabetes—a qualitative study from Portugal. European Journal of General Practice. 2015;21(2):103-10.
Eliacin J, Salyers MP, Kukla M, Matthias MS. Factors influencing patients’ preferences and perceived involvement in shared decision-making in mental health care. Journal of Mental Health. 2015;24(1).
Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Research and Clinical Practice. 2017;128: 40-50.
Zimmet P, Alberti KG, Magliano DJ, Bennett PH. Diabetes mellitus statistics on prevalence and mortality: facts and fallacies. Nature Reviews Endocrinology. 2016;12(10):616.
Nanditha A, Ma RC, Ramachandran A, Snehalatha C, Chan JC, Chia KS, et al. Diabetes in Asia and the Pacific: implications for the global epidemic. Diabetes Care. 2016;39(3):472-85.
Akhtar S, Khan Z, Rafiq M, Khan A. Prevalence of Type II diabetes in District Dir Lower in Pakistan. Pakistan journal of medical sciences. 2016;32(3):622.
Harashima S-i, Nishimura A, Ikeda K, Wang Y, Liu Y, Inagaki N. Once Daily Self-Monitoring of Blood Glucose (SMBG) improves Glycemic control in Oral Hypoglycemic Agents (OHA)–Treated Diabetes: SMBG-OHA Follow-Up Study. Journal of Diabetes Science and Technology. 2016;10(2):378-82.
Rhee E-J. Diabetes in Asians. Endocrinology and Metabolism. 2015;30(3):263-9.
Ranasinghe P, Mathangasinghe Y, Jayawardena R, Hills A, Misra A. Prevalence and trends of metabolic syndrome among adults in the asia-pacific region: a systematic review. BMC public health. 2017;17(1):101.
Control TD, Group CDR. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney International. 1995;47(6):1703-20.
Young LA, Buse JB, Weaver MA, Vu MB, Mitchell CM, Blakeney T, et al. Glucose self-monitoring in non–insulin- treated patients with type 2 diabetes in primary care settings: a randomized trial. JAMA Internal Medicine. 2017;177(7):920-9.
Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non- masked, randomised controlled trial. The Lancet. 2016;388(10057):2254-63.
Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline J-P, Rayman G. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Therapy. 2017;8(1):55-73.
Heinemann L, Deiss D, Siegmund T, Schlüter S, Naudorf M, von Sengbusch S, et al. Practical recommendations for glucose measurement, glucose monitoring and glucose control in patients with type 1 or type 2 diabetes in Germany. Experimental and Clinical Endocrinology & Diabetes. 2018;126(07):411-28.
Charity KW, Kumar AM, Hinderaker SG, Chinnakali P, Pastakia SD, Kamano J. Do diabetes mellitus patients adhere to self-monitoring of blood glucose (SMBG) and is this associated with glycemic control? Experiences from a SMBG program in western Kenya. Diabetes Research and Clinical Practice. 2016;112:37-43.
Wong JC, Foster NC, Maahs DM, Raghinaru D, Bergenstal RM, Ahmann AJ, et al. Response to Comment on Wong et al. Real-time continuous glucose monitoring among participants in the T1D exchange clinic registry. Diabetes Care. 2014;37:2702–2709. Diabetes Care. 2015;38(4):e61-e.
Lim S, Kang SM, Kim KM, Moon JH, Choi SH, Hwang H, et al. Multifactorial intervention in diabetes care using real-time monitoring and tailored feedback in type 2 diabetes. Acta Diabetologica. 2016;53(2):189-98.
Gao L, Ji L, Su Q, Feng B, Shan Z, Hu R, et al. Impact of structured self-monitoring of blood glucose on the quality of life of insulin-treated Chinese patients with type 2 diabetes-mellitus: Results from the COMPASS study. Diabetes Research and Clinical Practice. 2016;112:88-93.
Ong WM, Chua SS, Ng CJ. Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study. Patient Preference and Adherence. 2014;8: 237.
Vidal MF, Jansà MM, Galindo MR, Penalba MM. Factors associated to adherence to blood glucose self-monitoring in patients with diabetes treated with insulin. The dapa study. Endocrinologia, Diabetes y Nutricion. 2018;65(2):99-106.
Havele SA, Pfoh ER, Yan C, Misra-Hebert AD, Le P, Rothberg MB. Physicians’ views of self-monitoring of blood glucose in patients with type 2 diabetes not on insulin. The Annals of Family Medicine. 2018;16(4):349-52.
Sham SYZ, Thambiah SC, Samsudin IN, Chuan NO, Wei YS, Razmin NI. Practice of Self-monitoring blood glucose among insulin-treated diabetic patients in hospital serdang. Malaysian Journal of Medicine and Health Sciences. 2016;12(2):38-44.
Manroa P, Krupa Doshi M. Self-monitoring of blood glucose: Advice for providers and patients. Cleveland Clinic Journal of Medicine. 2016;83(5):355.
Al-Sahouri A, Merrell J, Snelgrove S. Barriers to good glycemic control levels and adherence to diabetes management plan in adults with Type-2 diabetes in Jordan: a literature review. Patient Preference and Adherence. 2019;13:675.
Agesen RM, Kristensen PL, Beck-Nielsen H, Nørgaard K, Perrild H, Jensen T, et al. Effect of Insulin Analogs on Frequency of Non–Severe Hypoglycemia in Patients with Type 1 Diabetes Prone to Severe Hypoglycemia: Much Higher Rates Detected by Continuous Glucose Monitoring than by Self-Monitoring of Blood Glucose—The HypoAna Trial. Diabetes Technology & Therapeutics. 2018;20(3):247- 56.
Hermanns N, Ehrmann D, Kulzer B. Continuous glucose monitoring-based technologies in hypoglycaemia- prone patients with type 1 diabetes. The lancet Diabetes & endocrinology. 2019;7(6):419-21.
Krishnan V, Thirunavukkarasu J. Assessment of knowledge of self blood glucose monitoring and extent of self titration of anti-diabetic drugs among diabetes mellitus patients–a cross sectional, community based study. Journal of clinical and diagnostic research: JCDR. 2016;10(3):FC09.
Fidler C, Elmelund Christensen T, Gillard S. Hypoglycemia: an overview of fear of hypoglycemia, quality-of-life, and impact on costs. Journal of medical economics. 2011;14(5):646-55.
Byers D, Garth K, Manley D, Chlebowy D. Facilitators and barriers to Type 2 diabetes self-management among rural African American adults. Journal of Health Disparities Research and Practice. 2016;9(1):9.
Pamungkas R, Chamroonsawasdi K, Vatanasomboon P. A systematic review: family support integrated with diabetes self-management among uncontrolled type II diabetes mellitus patients. Behavioral Sciences. 2017;7(3):62.
Dogru A, Ovayolu N, Ovayolu O. The effect of motivational interview persons with diabetes on self- management and metabolic variables. JPMA. 2019;69(294).
Shahar S, Fakhruddin NNINM, Hui KJ, Suhaimi NFS, Zulkepli NYF, Roslan R, et al. Family support and self- motivation influence dietary compliance and glycaemic control among type 2 diabetes mellitus outpatients. Jurnal Sains Kesihatan Malaysia (Malaysian Journal of Health Sciences). 2016;14(2).
Xie Y, Agiro A, Bowman K, DeVries A. Lowering cost share may improve rates of home glucose monitoring among patients with diabetes using insulin. Journal of Managed Care & Specialty Pharmacy. 2017;23(8):884-91.
Klatman EL, Jenkins AJ, Ahmedani MY, Ogle GD. Blood glucose meters and test strips: global market and challenges to access in low-resource settings. The lancet Diabetes & Endocrinology. 2019; 7(2):150-60.
Ugwu ET, Orjioke CJ, Young EE. Self monitoring of blood glucose among patients with type 2 diabetes mellitus in eastern Nigeria: Need for multi-strategic interventions. Current Diabetes Reviews. 2018;14(2):175-81.
Khowaja LA, Khuwaja AK, Cosgrove P. Cost of diabetes care in out-patient clinics of Karachi, Pakistan. BMC health services research. 2007;7(1):189.
Walker IF, Garbe F, Wright J, Newell I, Athiraman N, Khan N, et al. The economic costs of cardiovascular disease, diabetes mellitus, and associated complications in South Asia: a systematic review. Value in Health Regional Issues. 2018;15:12-26.
Afroz A, Chowdhury HA, Shahjahan M, Hafez MA, Hassan MN, Ali L. Association of good glycemic control and cost of diabetes care: experience from a tertiary care hospital in Bangladesh. Diabetes Research and Clinical Practice. 2016;120:142-8.
Mohan V, Mapari JA, Karnad PD, Mann JS, Maheshwari VK. Reduced diabetes mellitus-related comorbidities by regular self-monitoring of blood glucose: Economic and quality of life implications. Indian Journal of Endocrinology and Metabolism. 2018;22(4):461.
Morera J. Insulin Injection and Blood Glucose Meter Systems. Handbook of Diabetes Technology: Springer. 2019;3-21.
Shlomowitz A, Feher MD. Anxiety associated with self monitoring of capillary blood glucose. British Journal of Diabetes. 2014;14(2):60-3.
Mehmet S, Hussey C, Ibrahim S. Patients’ perceptions of injecting insulin and self‐monitoring of blood glucose in the presence of others. Practical Diabetes. 2015;32(2):59- 63.
Laranjo L, Neves AL, Costa A, Ribeiro RT, Couto L, Sá AB. Facilitators, barriers and expectations in the self- management of type 2 diabetes—a qualitative study from Portugal. European Journal of General Practice. 2015;21(2):103-10.
Eliacin J, Salyers MP, Kukla M, Matthias MS. Factors influencing patients’ preferences and perceived involvement in shared decision-making in mental health care. Journal of Mental Health. 2015;24(1).
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