Self-monitoring Of Blood Glucose Practice Research Articles

Practise of Self-Monitoring of Blood Glucose Among Pregnant Women with Gestational Diabetes Mellitus Attending a Tertiary Care Hospital in Lucknow, Uttar Pradesh

Background: Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance of varying degree diagnosed first time during the pregnancy. Blood glucose values revert to the normal level soon after the delivery. But the women carry a lifetime risk of getting overt diabetes within 5 years. The management of GDM mainly comprises of medical nutrition therapy, exercise, weight management and Self-Monitoring of Blood Glucose (SMBG). Among all the management components, SMBG is the mostly neglected especially among pregnant women with GDM.Overall, the practise of SMBG in developing nation like India is not up to the mark. Aim: The aim of the present study was to determine the practice of SMBG amongst the pregnant women with GDM. The study was conducted in the antenatal OPD of Queen Mary’s Hospital KGMU, Lucknow, Uttar Pradesh. Methodology: It was a quasi experimentalstudy on 188 pregnant women with GDM managed on life style intervention. Statistical analysis:Descriptive statistics in the form of frequencies and percentages were used to analyse the sociodemographicfactors. ANOVA was applied to compare the mean score between the two groups. Result: The overall adherence to the SMBG practice was found to be very low among the study participants. No significant difference was observed between the two groups. Conclusion: Patient empowerment and imparting proper information regarding SMBG may be helpful in managing the GDM with better maternal and foetal outcomes.

Blood Glucose Monitoring and Sharing Amongst People With Diabetes and Their Facilitators: Cross-sectional Study of Methods and Practices

BackgroundThe last two decades have witnessed a burgeoning rise in the prevalence of diabetes globally. It has already reached epidemic proportions in Saudi Arabia, with reported high risk among women. As a result, diabetes monitoring and self-management programs are being highly prioritized for diabetes control and management.ObjectiveTo investigate measuring and sharing practices of the self-monitoring of blood glucose (SMBG) among patients with type 1 or 2 diabetes using insulin.MethodsA cross-sectional study was conducted on a sample of 203 patients attending primary care clinics at a tertiary care center. The questionnaire assessed the measuring, recording, and sharing of SMBG practices of patients having diabetes with their physicians. The methods used for recording and sharing were categorized into paper-based and electronic-based. In addition, the determinants of the different methods used and frequency of sharing were analyzed.ResultsThe overall monitoring prevalence was 95% (193/203), and 57% (117/203) of participants shared the SMBG results. Among the 193 individuals that performed self-monitoring, 138 (72%) performed daily monitoring, and 147 (76%) recorded their blood sugar levels. Almost 55% (81/147) used paper-based materials like notebooks and paper for recording, while the rest (66/147, 45%) used digital devices like laptops and smartphones. A shift towards the use of digital devices and smart applications was observed in patients below 50 years of age. The digitally recorded blood glucose measurements were being shared thrice more often than the recordings made on paper or in notebooks (OR [odds ratio] 2.8; P=.01). Patients >50 years of age (OR 2.3; P=.02), with lesser formal education, married (OR 4.2; P<.001), with smaller family size (OR 2.6; P=.01), having type 2 diabetes (OR 4.1; P<.001) and any comorbid conditions (OR 2.6; P=.01) were associated with higher odds of using paper-based sharing methods. Only the female gender and type 2 diabetes were associated with increased frequency of sharing, while uncontrolled diabetes, the presence of other comorbidities, and duration of diabetes did not show any influence.ConclusionsGood monitoring and optimal sharing practices were found. Sharing using electronic devices can be emphasized. Diabetes self-management programs can incorporate the use of digital technology in training sessions. Digital literacy and its applications in health care may enhance SMBG practices resulting in better diabetes control.

Effectiveness of Management of Type 2 Diabetes Mellitus Through Telephone Consultation During COVID-19 Lockdown in Lagos Nigeria

Aim: The aim of the study was to explore the impact of the coronavirus disease 19 (COVID-19) lockdown on the clinical outcome of patients with Type 2 diabetes mellitus (DM) attending a primary care Diabetes Clinic in Lagos State, Nigeria, in terms of their compliance with medication intake, blood pressure (BP), and glycemic control and ability to modify medication through telephone consultation. Methodology: A retrospective review of the clinical characteristics of patients was carried out. Telephone calls were made to patients with Type 2 DM who attended the chronic medical disorder clinic of the Family Medicine Department, Lagos State University Teaching Hospital, Lagos, Nigeria. The information obtained included questions on demographic data, type of medications used, and medication compliance, use of self-monitoring devices for BP, and blood glucose levels. Data analysis was performed using SPSS program version 26. Results: A total of 178 patients were eligible. Most (87%) reported using their medication as prescribed, 74% of patients had self-monitoring of blood glucose (SMBG) during lockdown, though only 29% checked glucose level regularly and 54% practiced home monitoring of BP (HMBP). Medication was modified in 34% of patients by the doctor who called in. Biguanides and Sulfonylureas were the most prescribed oral antidiabetic medications, while Renin Angiotensin Aldosterone System (RAAS) blockers were the most prescribed antihypertensive class. The HMBP was associated with lower systolic BP (t-test 3.49,P= 0.0008). Conclusions: Type 2 diabetic patients managed through telephone during the COVID-19 lockdown reported good level of drug compliance, while improved practice of SMBG, and HMBP resulted in better level of control. The findings of this review suggest that the use of e-consultation can play a role in patient management of Type 2 diabetes even beyond the COVID-19 era including reaching patients in distant locations who are unable to come to the hospital. There is a need for further studies on e-medicine role on various aspects of medical care.

Diabetes self-care practice and disease knowledge in patients with type 2 diabetes mellitus: A cross-sectional analysis with respect to age, educational attainment, income class and ongoing anti-diabetic treatments

Objective: To evaluate diabetes self-care practice and disease knowledge in type 2 diabetes mellitus (T2D) patients with respect to age, educational attainment, income class and antidiabetic treatments. Methods: A total of 583 patients with T2D (mean (SD) age: 57.3 (9.5) years, 55.9% females) were included in this cross-sectional study. Data on sociodemographic characteristics, diabetes characteristics (duration, current treatment), diabetes self-care practice [forgetting to take anti-diabetic medication, discontinuation of treatment due to side effects, self-monitoring of blood glucose (SMBG), diabetes education and regular exercise] and disease knowledge (definition and target levels of HbA1c, hypoglycemia symptoms and diabetes-related complications) were recorded. Results: Overall, HbA1c levels were &gt;8% in 53.2% of patients, 38.3% of patients reported that they had no diabetes education, while at least twice daily SMBG and regular exercise was reported by 27.4% and 19.7% of patients, respectively. Lack of knowledge on definition and target levels of HbA1c was noted in up to 65.5% of patients, while majority of patients reported that they know hypoglycemia symptoms (89.2%) and diabetes-related complications (86.4%). Illiteracy was associated with higher likelihood of treatment discontinuation (p&lt;0.001) and with lesser likelihood of performing regular exercise (10.3 vs. 32.8%, p&lt;0.001). Older patient age, lower educational attainment and lower income level were associated with lesser likelihood of knowing the definition or target levels of HbA1c (p&lt;0.001 for each) and sexual complications of diabetes (p&lt;0.001, p&lt;0.001 and p=0.028, respectively). Knowing diabetes-related complications were less common in those with lower educational attainment (p&lt;0.001) and lower income level (p=0.010), while insulin-naïve patients were less likely to know hypoglycemia symptoms (p=0.010). Conclusion: In conclusion, our findings revealed poor glycemic control, low level of knowledge on definition and targets of HbA1c and lack of diabetes education with suboptimal adherence to self-care practice in a considerable percentage of patients. Disease knowledge but not SMBG practice significantly differed with respect to patient age, educational attainment, income class and treatment. Our findings seem to indicate lower disease-related insight among older patients and those with lower educational and income levels, emphasizing the potential role of individualized diabetes education interventions tailored to needs of patients to improve disease knowledge and thus the adherence to self-care practice in T2D patients.

Knowledge, Practice, and Barriers Regarding Self-monitoring of Blood Glucose Among Patients with Type 2 Diabetes Mellitus in Enugu State, Nigeria

Aims: Self-monitoring of blood glucose can improve treatment adherence and clinical outcomes. The aim of this study is to assess knowledge, practice, and barriers to self-monitoring of blood glucose (SMBG) among patients with type 2 diabetes mellitus (T2DM) in Enugu State, Nigeria. Settings and Design: This study was a cross-sectional survey of 340 patients with type 2 diabetes at the University of Nigeria Teaching Hospital (UNTH) and Enugu State University Teaching Hospital (Park Lane) in August 2017. Materials and Methods: The data collection tool was a 26-item, four-sectioned questionnaire: the socio-demographic and clinical characteristics, 11 items on knowledge, seven on practice, and eight on barriers regarding SMBG. The questionnaires were self-administered. Statistical Analysis Used: Data were analyzed using SPSS version 20. Descriptive, χ2, Spearman's correlation, and logistics regression statistics were reported at P &lt; 0.05. Results: Majority of the patients were 46–55 years old (27.9%). Female respondents were 53.5%. Patients with good knowledge and practice were 35.9% and 46.2%, respectively. Knowledge of SMBG was negatively correlated to barrier against SMBG (r = -0.178, P=0.001) and positively correlated with practice of SMBG (r = 0.138, P=0.011). Those who were not taught SMBG were less likely to have good practice of SMBG than those who were taught (adjusted odd ratio 0.122, 95% confidence interval: 0.044–0.338). Conclusions: Patients with T2DM in Enugu State have poor knowledge and practice SMBG.

Pattern of Self-care practices among type 2 diabetes patients in Southwest, Nigeria.

Self-care practices in individuals with diabetes are important skills required to effectively prevent, manage, and limit complications associated with diabetes since patients spend considerably less time with health care providers than spend alone to manage their diabetes condition. The aim of the study was to assess self-cate practices and their determinants among patients with type 2 diabetes. Hence, this study aimed at assessing self-care practices and their determinants among patients with type 2 diabetes. This cross-sectional, descriptive, multi-center study was conducted among 348 type 2 diabetes patients selected from six tertiary hospitals in Southwest Nigeria. Descriptive statistical analysis was employed for categorical and continuous variables and multivariable logistic regression assessed association between determinant factors and adherence to self-monitoring of blood glucose (SMBG). Of the study participants, 83.1%, 66.9%, 28.4%, and 27.9% adhered to prescribed medications, physical exercise, had meal plans incorporated into their diabetes management and SMBG, respectively. There was a statistically significant association between male gender, duration of diabetes, and previous episode of hypoglycemia with adherence to SMBG practices while lower educational level and use of insulin were associated with less likelihood of adherence to prescribed medications. The degree to which individuals with diabetes adhered to recommended self-care practice components were less than satisfactory especially SMBG, physical activity, and having meal plans.

Social factors associated with practice of self-monitoring of blood glucose among type-2 diabetic patients

Background: Self-monitoring of blood glucose (SMBG) is an effective self-management tool to achieve desirable haemoglobin A1c (HbA1c) targets and minimizing glucose variability, when the data is timely reviewed and acted upon by healthcare providers and diabetic patients to actively modify behaviour and/or adjust treatment. SMBG improves patient’s disease awareness and participation in disease management.Methods: This cross-sectional study was conducted at Basaveshwara Hospital, Chitradurga, to estimate percentage of type-2 diabetics practicing SMBG and to assess social factors associated with SMBG practice. Diabetic patients in age-group of 18-75 years were included in the study. Information was collected by interview technique, clinical examination and review of laboratory reports.Results: A 21.5% patients were practicing SMBG. SMBG practice was significantly higher among patients who were urban-area residents (25.0%), with higher educational qualifications (42.2% of patients who studied up-to 12th standard and/or above), with better awareness of diabetes self-management (28.9%) and with better socio-economic status (35.3%). Majority of patients with longer duration of diabetes (4.9±1.5 years), relatively older age group (57.3±2.5 years), with associated co-morbid conditions (26.8%) were found to be practicing SMBG. HbA1c levels were significantly lower among SMBG practicing group (6.6±0.7%).Conclusions: Better health literacy, higher educational qualifications, financial stability, easier access to specialized anti-diabetic health-care are favourable factors for SMBG practice. Study also highlighted favourable effect of SMBG practice on effective achievement of target HbA1c levels.

Adherence to self-monitoring of blood glucose in Chinese patients with type 2 diabetes: current status and influential factors based on electronic questionnaires.

Background and purposeSelf-monitoring of blood glucose (SMBG) is important to the management of diabetes mellitus, yet most patients with type 2 diabetes mellitus (T2DM) do not perform SMBG as recommended. The current status and influential factors of SMBG in China have not been well investigated. This study aimed to describe the present status of SMBG adherence in China and investigate the influential factors based on electronic questionnaires.Patients and methodsA cross-sectional study was conducted from June to July of 2017 at hospitals in Changsha, China. Seven hundred and twenty-one patients with T2DM completed the information‑motivation‑behavioral (IMB) skills questionnaire and other electronic questionnaires composed of demographic and clinical characteristics as well as diabetes-related and psychological scales. Univariate comparisons and multivariate logistic regression were used to explore the relationships among SMBG adherence and related factors.ResultsSeven hundred and twenty-one patients with valid questionnaires were included. Only 27.5% (198/721) of the patients with T2DM were SMBG adherent based on the guideline of the Chinese Diabetes Society (CDS) in 2017. Among all groups of treatment regimens, the rate of SMBG adherence was highest at 36.6% (82/224) in patients on oral hypoglycaemic drugs (OHAs). In multivariable analysis, the treatment of OHAs (OR =3.731, CI 2.162–6.437) and diet/exercise (OR =3.534, CI 1.841–6.783), the patient having their own blood glucose meter (OR =6.916, CI 4.054–11.800) and a higher education level (OR =3.780, CI 1.688–8.466) were significantly associated with SMBG adherence.ConclusionMost Chinese patients with T2DM did not perform SMBG as recommended. The treatment of OHAs and diet/exercise, the patient having their own blood glucose meter, a higher education level and other factors were correlates of SMBG adherence. There is clearly a need for prospective, multicenter, large-scale studies to explore the reasons for patients’ failure to practice SMBG adherence.

Impact of Self-monitoring of Blood Glucose on Glycaemic Control in Type 2 Diabetic Nigerians who Reside in Lagos

Background: Self-Monitoring of Blood Glucose (SMBG) is a vital constituent of diabetes care. The aim of this study was to document the practice, determinants and effects of SMBG in our setting. Methods: A cross-sectional study was carried out on 249 adult type 2 diabetic subjects who attended the diabetes clinic of the Lagos State University Teaching Hospital Ikeja. The statistical analysis was done with independent t-test and logistic regression. A P-value of less than 0.05 was taken as significant. Results: The age of the study subjects ranged from 28 years to 87 years. The mean + S.D age is 62 + 11 years. The mean + S.D BMI of the study subjects is 27.79 + 4.73 Kgm2. 159 (64%) of the patients practised SMBG while 90 (36%) patients did not. Twenty-two (14%) of the patients have been practising SMBG for less than 12 months, 71 (46%) patients for 12 - 36 months, while 60 (39%) of them for more than 36 months. 36 (23%) of the patients did SMBG daily, 58 (37%) patients twice weekly, 48 (30%) patients weekly, 11 (7%) patients monthly, 5 (3%) patients did it for unspecified time period while 1 (1%) patient was unable to report the time period. SMBG practice was associated with better short term glycemic control P= &lt; 0.001, OR= 0.399 and 95% CI 0.229-0.693. Predictors of SMBG were male sex, higher socioeconomic status and insulin therapy. More male patients (72.7%) practice SMBG compared to female patients (59.9%) p-value 0.051. The detection of chronic complications of DM was comparable between those who practice SMBG and those who do not. Conclusion: SMBG practice is significantly associated with better short term glycaemic control.

Selfmonitoring of blood glucose practices by people living with diabetes who use their personal glucometers in Port Harcourt, Niger Delta Region, Nigeria

Self-monitoring of blood glucose (SMBG) assists persons living with diabetes with the day-to-day behavioral and therapeutic adjustments to their diabetes care. It is a cheaper and more available alternative to glycated haemoglobin (HbA1c) in Nigeria for monitoring glycaemic control. Information on SMBG practices of Nigerians living with diabetes using their personal glucometers is scanty. The aim of the study is to assess the intensity and frequency of SMBG by glucometer owners, and the extent the patients and/or the health care providers (HCP) utilize SMBG to achieve personalized treatment goals via behavioral/treatment adjustments. This was a cross sectional study carried out among persons living with diabetes that accessed diabetes care at the diabetes clinic of the University of Port Harcourt Teaching Hospital (UPTH) and using their personal glucometers. They were consecutively recruited. Data obtained by using intervieweradministered questionnaires were analyzed using SPSS version 20.0, and pvalue &lt;0.05 was considered significant. A total of 128 persons living with diabetes participated in the study of which 40 (31%) were males and 88 (69%) were females; the mean age of the subjects was 52.05 ± 11.24 years with a range of 26–70 years. The majority of the study subjects (72%) were in the active working age group (25–60years). The highest frequency of glucometer use was in the 26 subjects (20%) who checked their blood glucose every morning while 62 (48%) of the subjects checked their blood glucose any morning they felt like. Most of the subjects (60%) did not have any recording device. Glucometer owners were not just the insulin-requiring people living with diabetes as more than half of the subjects, 66 (52%) were on oral anti diabetic drugs (OAD) only. Glucometer ownership was mainly by those that were in the working age group. SMBG protocol (frequency) was variable and SMBG data were not maximally utilized.Keywords: Self-monitoring of blood glucose; Personal glucometer; Diabetes; Blood glucose

Self Monitoring of Blood Glucose Among Patients with Type 2 Diabetes Mellitus in Eastern Nigeria: Need for Multi-strategic Interventions

Self Monitoring of Blood Glucose (SMBG) is a useful adjunct to lifestyle modification and medications for optimal management of type 2 Diabetes Mellitus (DM). This study was aimed at evaluating the practice, cost and associations of SMBG in subjects with type 2 DM in Enugu, Nigeria. In a cross-sectional survey conducted at the diabetes clinic in three hospitals, 366 type 2 diabetic subjects aged 18-65 years were consecutively interviewed. Socio-demographic and clinical information were documented and glycated hemoglobin was performed for all the participants. A total of 318 subjects with mean age of 49.0 ± 9.4 years completed the study. 304 subjects (95.6%) reported that they were aware of SMBG and 60.7% practiced SMBG at frequencies ranging from ≥ 1/day (7.9%), ≥ 1/week (26.1%) or < 1/week (26.7%). 39.3% of the respondents did not perform any SMBG. Lack of finance was the predominant reason for not performing any SMBG. The median monthly cost of performing SMBG excluding the cost of meters was N2,000 (USD 6.7) per patient, amounting to annual societal cost of N37.8 billion (USD 126 million). Significant associates of performing any SMBG were longer DM duration, previous participation in diabetes education, insulin treatment and infrequent hospitalization. Despite high awareness, SMBG practice is grossly inadequate and is associated with a huge economic burden that may be unsustainable in a resource-poor country like Nigeria. Measures aimed at reducing the cost of glucometers and strips, and improving diabetes education are recommended.

Self-monitoring of blood glucose: Is it justified?

Despite the availability of robust evidence demonstrating that lowering glycaemic levels reduces the risks of diabetes-related complications, there has been little improvement in recent years in glycaemic control among individuals with diabetes in Europe and the US. Although widely used, there has been considerable controversy surrounding the role of self-monitoring of blood glucose (SMBG) as a means of achieving glycaemic control. This has resulted in a re-consideration of the prescription of blood glucose strips especially in the current climate of health care cost-containment. Existing clinical recommendations lack specific guidance to patients and health professionals regarding SMBG practice intensity and frequency, particularly for those not treated with insulin. Previous studies of the association between SMBG and glycaemic control found often weak, and sometimes conflicting, evidence. More rigorous longitudinal studies are needed to examine the role of SMBG with special attention to the unique needs of patients using different diabetes treatments, within special clinical sub-populations, and during initiation of SMBG versus its ongoing use. Further understanding of the intensity and frequency of SMBG are also needed to capture variability in glycaemic patterns in order to facilitate more specific guideline development.

Opportunity Cost and Policy: A Utilization Review of Self-monitoring of Blood Glucose in Manitoba, Canada

PurposeRecently, there has been a re-evaluation of the frequency, benefits, and costs associated with self-monitoring of blood glucose (SMBG). Based on little evidence of the benefit of frequent SMBG in patients with diabetes not using insulin, new guidelines and test strip limit policies have been suggested and implemented in various Canadian jurisdictions to promote a more selective practice of SMBG. The objective of this study was to assess the overall utilization and cost associated with test strips and lancets for SMBG in Manitoba from 2000 to 2013 as well as to explore the policy implications of the implementation of test strip quantity limits and its impact on overall and government costs. MethodsAn analysis of prescription claims for blood glucose test strips (BGTSs) and lancets for all patients with diabetes in Manitoba from 2000 to 2013 was conducted. In each year, patients were stratified into 4 mutually exclusive hierarchical groups according to most intensive diabetes treatment. Test strip and lancet utilization and cost were assessed for each group in each year, and the potential cost savings associated with implementation of a BGTS limit policy was projected using autoregressive integrated moving average models. FindingsIn the year 2000, 8 million test strips were dispensed in Manitoba, increasing by 170% to 21.7 million test strips in 2013. Insulin users accounted for the majority of test strip use. However, based on potential implementation of test strip limit policies, 95% of the reduction of test strip use is predicted to occur in the groups not using insulin. Based on current trends, the 5-year predicted additional cost associated with not implementing a test strip limit policy similar to that implemented in other Canadian provinces was estimated to be a total of $12.35 million. ImplicationsImplementation of the guideline-based policy limits is predicted to produce considerable savings, with 95% of potential savings occurring in patients not using insulin. There is, therefore, a significant opportunity cost associated with not implementing a policy to reduce BGTS utilization by patients with diabetes in Manitoba. Based on the lack of evidence to suggest significant outcome improvements with long-term frequent SMBG by patients not using insulin, more selective use of test strips for SMBG could allow for significant cost savings that could be redirected to other programs and interventions for the growing population of patients with diabetes in Manitoba.

Self-monitoring of blood glucose in Jos, Nigeria

Background: Self-monitoring of blood glucose (SMBG) is considered one of the cornerstones of diabetes care and is an important component of modern therapy for diabetes mellitus. Methods: This was a descriptive cross-sectional study carried out at the diabetes clinic of Jos University Teaching Hospital (JUTH) and a private specialist clinic in Jos, North central Nigeria. One hundred and eighty patients on treatment for diabetes aged 18 years and above diagnosed to have diabetes but not less than six months were recruited consecutively. Patients on dietary management and patients with Gestational Diabetes Mellitus (GDM) were excluded from the study. Data was obtained using a questionnaire. Results: Ninety six (53.3%) were males. The mean age was 56 ± 11 years. The median (range) duration of diabetes was 9.0 (3.0 - 12.5). One hundred and eighteen (65.5%) had either secondary or tertiary education with one hundred and three (57.2%) earning less than N500,000 yearly. The prevalence of self monitoring of blood glucose (SMBG) was only 47.8 % with more than 50% not practicing SMBG as recommended by the American Diabetes Association. Factors associated with SMBG include high level of education, high income (>N 1.5 million yearly), long duration of diabetes (≥10 years) and male sex. Conclusion: The practice of SMBG in our environment is suboptimal with those practicing it not doing it as recommended. Hence, increased awareness and education of patients with diabetes should be promoted among those who do not practice SMBG and those who do not practice it as recommended.

Self-monitoring of Blood Glucose (SMBG): Cornerstone of Diabetes Management- Bangladesh Perspective: A Recommendation

SMBG is a crucial factor in diabetes management. It offersa quick check of glycemic status, helps to identify hypoglycemia and hyperglycemia. In addition SMBG assists in clinical decision making and as such it complements HbA1c. But due to many reasons SMBG is not practiced properly and adequately. In recent years several international guidelines higllighted the importance of SMBG for diabetes management. Very few diabetic patients in Bangladesh actually perform SMBG regularly at home. The awareness of the benefits of SMBG is also low. There is no uniformity in SMBG practice among the patients as there is no local guideline to help the physicians in determining the optimum SMBG frequency for their patients. So a working guideline on SMBG is the call of the day. This article is an attempt in that direction. Exploring international guidelines and evaluating their applicability in local context a number of recommendations have been proposed.J Bangladesh Coll Phys Surg 2014; 32: 218-223

The two levels of care for diabetes in a developing country: Mechanisms for improved intermediate health outcomes

India has over 70 million citizens with diabetes, the second-most of any country worldwide. Disparities in learning skills, resources, education, and physician practices make it difficult to practically implement the diabetes management guidelines recommended by international scientific organizations. In its guidelines, the International Diabetes Federation advocates for three different levels of care based on availability of resources.This study investigates the differences in intermediate health outcomes between two diabetes care programs: one a comprehensive diabetes centre, the other a limited care setting. The comprehensive centre offers telemedicine and periodic diabetes education, empowering patients and providing 24-hour advice on lifestyle modifications, diet, and exercise. All patients of this centre practice self-monitoring of blood glucose. The subjects in the limited care setting receive minimal investigations and periodic physical follow-ups, and few patients have access to home glucose monitoring.The results showed that HbA1c (7.62 vs. 8.58, p=0.003), cholesterol (134.4 vs. 173.4, p<0.001), and diastolic blood pressure (72.9 vs. 77.0, p=0.016) were significantly lower in patients receiving comprehensive care, while the reductions in systolic blood pressure (134.6 vs. 138.7, p=0.202) did not achieve statistical significance. These reductions, which remained significant after correcting for confounding factors, could be attributed to more aggressive treatment regimens in the comprehensive care centre, as well as the real-time, frequent communication with medical professionals in the telemedicine program.

Self-monitoring of blood glucose among diabetic patients attending Al-Eskan Primary Health Care Center in Makkah Al-Mukarramah city

Background: Self-monitoring of blood glucose (SMBG) is recognized by leading medical organizations as an important tool in diabetes management, particularly in insulin-treated patients. However, some believe the utility of SMBG in non-insulin-treated type 2 diabetes mellitus (T2DM) remains controversial. Objectives: To estimate the prevalence of SMBG, its frequency, and influencing factors among diabetic patients attending Al-Eskan Primary Health Care Center, Makkah Al-Mukarramah city. Materials and Methods: A cross-sectional analytic study was conducted including a representative sample of diabetic Patients attending Al-Eskan Primary Health Care Center in Makkah Al-Mukarramah city. Every third patient who attended for follow-up in the center was recruited in the research until the target number was achieved. Two sets of questionnaires were developed in English language and validated in a Malaysian study, and consequently used in the present study. One set of questionnaire was for diabetic patients who performed self-monitoring consisted of five parts; personal data, information about the patient’s diabetes and treatment, the patient’s perception regarding diabetes and his health, the patient’s belief and attitudes toward SMBG, and the patient’s current SMBG practices. Another set of questionnaire was for those who did not perform self-monitoring. It was similar except in part 4 where different statements were used to assess the patient’s perception and attitude toward SMBG. Results: The study included 120 patients with T2DM. The prevalence of SMBG among them was 70.8%. Among those who are practicing SMBG, 28.2% practiced it on daily basis whereas 10.6% practiced it more than once daily. Almost one third of them (35.3%) recorded their blood glucose monitoring results. Only 22.4% showed their results to their physicians and 25.9% adjusted their diabetes treatment based on blood glucose results. Sixty-nine respondents (57.5%) needed further help and information regarding diabetes with no significant association with SMBG practice. It was found that younger (≤50 years), male, married, and higher educated diabetic patients were more likely to practice SMBG, regardless of its frequency. All information related to diabetes (duration, therapy, complications, hospitalization, recent HbA1C, and attending educational sessions) was not significantly associated with SMBG practice. Conclusion: SMBG is widely used among patients with T2DM in Al-Eskan Primary Health Care Center in Makkah Al-Mukarramah city. However, its frequency and timing is suboptimal. As younger (≤50 years), male, married, and higher educated diabetic patients were more likely to practice SMBG.

The relationship between self-monitoring of blood glucose and glycaemic control among patients attending an urban diabetes clinic in Nigeria.

Self-monitoring of blood glucose (SMBG) is a component of modern diabetes mellitus (DM) self-management. Its value is discussed controversially, and its impact in resource poor settings has been infrequently studied. The aim of this report is to determine the pattern of SMBG and its relationship with glycemic control amongst type 2 DM (T2DM) patients attending an urban DM clinic in Lagos, Nigeria. Data were collected from patients with T2DM in a cross-sectional study, using systematic random sampling, with an interviewer-administered questionnaire investigating demographic data, DM history and SMBG practice. Weight, height, fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) were measured. One hundred patients were studied consisted of 62 (62%) females and 38 (38%) males. The mean age, body mass index and HbA1c of the study population were 59.9 (9.5) years, 26.2 (5.6) kg/m2 and 7.9 (2.2%). The median (interquartile range [IQR]) FPG and duration of DM were 107.0 (82.0-142.0) and 8.5 (5.0-15.0) years respectively. SMBG was practiced by 40 (40.0%) patients with a median (IQR) of 6 (4-15) times/month. SMBG was performed more frequently by persons with tertiary level of education (P = 0.04) and DM duration ≥ 8.5 years (P = 0.04). The mean HbA1c in the group who practiced SMBG was lower though not statistically significant compared to the group that did not (7.8% vs. 8.0%, P = 0.61) practiced. The Spearman's rank correlation coefficient between the frequency of SMBG and HbA1c was -0.025, and P = 0.81 among the entire T2DM patients. There was no statistically significant relationship between SMBG and glycemic control. There is a need for larger studies to be carried out in order to justify the value of SMBG in resource poor settings.

Diabetic Patients' Knowledge of Their Disease, Therapeutic Goals, and Self-management: Association With Goal Attainment at Dessie Referral Hospital, Ethiopia.

This study aims to assess diabetic patients' knowledge of their disease, therapeutic goals, self-management, and its association with goal attainment at a hospital in Ethiopia. A prospective cross-sectional study was conducted from February to March 2012 at the diabetic follow-up clinic of Dessie Referral Hospital. Diabetic patients who came for their diabetic follow-up were included consecutively until a calculated sample size of 303 was obtained. Data were collected by face-to-face interview through a pretested structured questionnaire and by medical record review. Binary logistic regression analysis was used to determine predictors of fasting glycemic control. Ninety-nine patients (32.7%) had poor knowledge about their disease. The average fasting blood glucose was 226.57 ± 85.86 mg/dL, and only 61 patients (20.1%) achieved the recommended fasting glycemic goal (70-130 mg/dL). Diabetic patients who had poor knowledge were 5.53 times (95% confidence interval [CI]: 1.85, 16.49) more likely to not attain fasting glycemic goal compared to those who had good knowledge. Patients who did not practice self-monitoring of blood glucose were 3.09 times (95% CI: 1.33, 7.21) more likely to not attain fasting glycemic goal than those who practiced. Failure to achieve fasting glycemic goal was 2.43 times (95% CI: 1.15, 5.13) more common among patients who did not regularly exercise as compared to those who did. Patients who did not adhere to their medication were 3.72 times (95% CI: 1.69, 8.20) more likely to fail to achieve fasting glycemic goal compared to those who adhered to their medication. Fasting glycemic control was below the recommended standard among the study participants. Glycemic control was poor among patients who had poor knowledge, did not practice self-monitoring of blood glucose, did not participate in regular exercise, and were nonadherent to their medication. This study population had poor knowledge about their disease.

Self monitoring of blood glucose level among diabetic patients in Muscat, Oman: A pilot study

Introduction: Monitoring of blood glucose (BG) is an important aspect of the diagnosis and management of diabetes. Self monitoring of blood glucose (SMBG) of patients at home can provide patients and physicians with valuable information in the management of diabetes mellitus. Objective: The aim of this pilot study was to assess the awareness, attitude and practice of SMBG among primary care diabetic patients in Muscat region. Materials and Methods: The study was conducted in two phases. In the first phase 140 patients attending diabetes clinics at various health centers in Muscat region were interviewed to identify patients who practice SMBG. In the second phase a closed ended questionnaire containing 10 questions related to demographic characteristics and attitude was self administered to 50 patients recruited from the first phase to generate the data. Results: It was found that only one third of the patients use glucometer to monitor their BG at home. However, majority of the patients were aware of the significance and importance of glucose home monitoring and thus recommended the practice of SMBG to other diabetic patients. Participants acknowledged the role of pharmacist in educating and training the patient about the proper use of glucometers. Patients were convinced with the device performance and pricking finger was not a deterrent, but at the same time the frequency of BG monitoring was poor among the participants. Conclusion: Overall the participants had a positive attitude towards SMBG but there is a room for the improvement among the participants who showed poor frequency of BG monitoring. There is a need to aware and educate the Omani diabetic patients about the importance of SMBG to achieve the desired therapeutic goals.