Frequency and motives of blood glucose self-monitoring in type 1 diabetes
Introduction
Achievement and maintenance of near normoglycaemia resulting in reduced incidence or progression of long-term complications are goals for the treatment of patients with type 1 diabetes. In the DCCT and the EDIC follow-up study, intensive therapy consisted of multiple injections or pump-based basal-bolus insulin therapy and self-monitoring of blood glucose (SMBG) ≥4 times per day [1], [2]. In contrast to basal-bolus insulin therapy, which is today the standard treatment of type 1 diabetes, the SMBG recommendations (measuring at least 4 times daily) from the DCCT have not been implemented with the same intensity. This may be due to the less clear documentation of the effect of SMBG. Two earlier studies have not shown a benefit from using SMBG as compared to urine glucose self-monitoring in type 1 diabetes [3], [4] and a systematic review [5] did not provide evidence to support the clinical effectiveness of SMBG in improvement of glycaemic control. However, current clinical practice recommendations from the American Diabetes Association [6] and the Global Consensus Conference on Glucose Monitoring [7] encourage the use of daily SMBG. For most patients with type 1 diabetes, SMBG is recommended three or more times daily, although the frequency and timing of SMBG should be adapted to the particular needs and goals of the individual patient [6], [8], [9]. Even though present recommendations are clear, adherence to blood glucose monitoring is suboptimal as number of patients who never practice SMBG vary from 6% to 21% [9], [10], [11], [12], [13], [14].
The aim of this cross-sectional study was to assess the frequency and the motives for measuring blood glucose in daily life in patients with type 1 diabetes and to identify patient characteristics that are associated with adherence to SMBG.
Section snippets
Subjects
In all four centres we consecutively included adult (>18 years of age) outpatients with clinical type 1 diabetes mellitus for more than 2 years. Data were collected between February 1999 and May 2000. Type 1 diabetes was defined by diagnosis before the age of 40 years and insulin treatment from the time of diagnosis. We only excluded those with end stage renal disease (haemodialysis), concomitant malignant disease, pregnancy or an inability to complete the questionnaire. The study was approved
Materials and methods
The study was a four-centre cross-sectional questionnaire survey including clinics at one Danish general hospital (Hillerød Hospital), one Danish university hospital (Steno Diabetes Center) and two British university teaching hospitals (Northern General Hospital, Sheffield and Radcliffe Infirmary, Oxford). An analysis of severe hypoglycaemia has been published previously [15].
Results
Of 1183 subjects asked to participate, 1076 patients (91%) completed the study (Table 1). Non-participants had a slightly higher prevalence of microvascular diabetic complications but their characteristics did not otherwise differ from those of the participants (Table 1 in Ref. [15]). A total of 96.6% reported to do SMBG and 3.4% did not. Test frequency was distributed in four groups: 24% tested less than weekly, 17% did single tests more than once a week, 20% did series one or more days per
Discussion
This study shows that patient compliance to guidelines regarding SMBG is suboptimal. Thus, 3% of patients do not perform SMBG at all, 33% do not perform routine tests, and 61% do not test on a daily basis. This is in accordance with earlier studies [10], [11], [12], [13], [14], [20], [21], [22], [23] suggesting that the self-monitoring recommendations from the DCCT have not been possible to implement in clinical practice.
Both the Danish Diabetes Association and Diabetes UK recommend daily
Conflict of interest
The authors state that they have no conflict of interest.
Acknowledgments
The authors are indebted to the research nurses Pernille Banck-Petersen (Hillerød Hospital), Susan Hudson (Northern General Hospital, Sheffield), and Victoria Wright (The Radcliffe Infirmary, Oxford) for thorough collection of data, and to Philip Hougaard (Lundbeck A/S, Copenhagen, Denmark) for statistical assistance. The study was funded by grants from The Foundation of Harald Jensen and Wife, The Foundation of Olga Bryde Nielsen, The Foundation of Region 3, and Novo Nordisk A/S.
References (32)
- et al.
Epidemiology and determinants of blood glucose self-monitoring in clinical practice
Diabetes Res. Clin. Pract.
(1996) - et al.
Activity of angiotensin-converting enzyme and risk of severe hypoglycaemia in type 1 diabetes mellitus
Lancet
(2001) - et al.
Self-monitoring of blood glucose in people with type 1 and type 2 diabetes living in France: The Entred Study 2001
Diabetes Metab.
(2008) - et al.
Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanent diabetes registry
Am. J. Med.
(2001) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus
N. Engl. J. Med.
(1993)- The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group....
- et al.
Intensive attention improves glycaemic control in insulin-dependent diabetes without further advantage from home blood glucose monitoring: results of a controlled trial
Br. Med. J.
(1982) - et al.
Effectiveness and cost-benefit analysis of intensive treatment and teaching programmes for type 1 (insulin-dependent) diabetes mellitus in Moscow—blood glucose versus urine glucose self-monitoring
Diabetologia
(1994) - et al.
Monitoring of blood glucose control in diabetes mellitus: a systematic review
Health Technol. Assess.
(2000) Standards of medical care in diabetes
Diabetes Care
(2008)
The role of self-monitoring of blood glucose in the care of people with diabetes: report of a global consensus conference
Am. J. Med.
Self-monitoring of blood glucose
Diabetes Care
Development and testing of the barriers to self-monitoring blood glucose scale
Diabetes Educ.
Adherence to self-care and glycaemic control among people with insulin-dependent diabetes mellitus
J. Adv. Nursing
Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database
BMJ
Factors associated with adherence to self-monitoring of blood glucose among persons with diabetes
Diabetes Educ.
Cited by (62)
Introduction to SMBG
2020, Glucose Monitoring Devices: Measuring Blood Glucose to Manage and Control DiabetesRole of Social Factors in Glycemic Control Among African American Children and Adolescents with Type 1 Diabetes
2019, Journal of the National Medical AssociationCitation Excerpt :Our study showed a 2 point decrease in mean A1C in patients with more frequent BGM to 3-4x/day when all patient were included. Patients with 3-4 x/day BGM had an A1C of 9.6 ± 2.24% vs. those with ≤2 x/day with A1C of 11.8 ± 1.95% (95% CI 0.2-3.7, p = 0.03) which support previous studies findings.21–24 Contrary to that reported in the study by Miller et al. wherein A1C consistently decreased with increase in the number of BS checks per day,22 our study showed no further improvement in A1C with BS checks >4x/day.
Personalizing the Use of a Intermittently Scanned Continuous Glucose Monitoring Device in Individuals With Type 1 Diabetes: A Cost-Effectiveness Perspective in the Netherlands (FLARE-NL 9)
2024, Journal of Diabetes Science and TechnologyValidation and optimization of the French Generic Adherence for Chronic Diseases Profile (GACID-P) using classical test and item response theory
2023, Health and Quality of Life OutcomesDeterminants of Self-Monitoring of Blood Glucose in Iranian Children and Adolescents with Type 1 Diabetes
2023, International Journal of Endocrinology and MetabolismTo the question of the influence of intestinal microflora on the course of mental diseases
2023, Clinical Review for General Practice