Perspectives of patients with type 1 or insulin-treated type 2 diabetes on self-monitoring of blood glucose: a qualitative study

Abstract

BackgroundSelf-monitoring of blood glucose (SMBG), including self-regulation, is an important tool to achieve good glycemic control. However, many patients measure their glucose concentrations less often than is recommended. This study investigates patients' perspectives of SMBG and all relevant aspects influencing SMBG in patients with type 1 and insulin-treated type 2 diabetes.MethodsIn depth interviews were conducted with 13 patients with type 1 diabetes from an outpatient clinic and 15 patients with type 2 diabetes from general practices. All interviews were transcribed verbatim and analyzed using the Grounded Theory approach.ResultsA wide variety of SMBG was encountered. Perceptions, goals of SMBG and personal and contextual factors were identified, influencing the respondents' perspective of SMBG, and leading to this variety. Respondents experienced a discrepancy between their own and the professionals' perceptions and goals. Respondents' perception of SMBG ranged along a continuum from 'friend' to 'foe'. With respect to the goals, the respondents experienced tension between achieving good glycemic control and quality of life, and deliberately made their own choices. The performance of SMBG was tailored to their perceptions and personal goals. Personal and contextual factors such as hypo- or hyper (un)awareness, knowledge, and contact with professionals acted as either facilitating factors or as barriers to SMBG, depending on the respondents' perspective. A SMBG model was developed providing a representation of the factors and their interrelations.Respondents with type 1 diabetes seemed more resigned to their situation and SMBG was more integrated into their lives.ConclusionsFrom the patients' perspective, professionals positively present SMBG as a 'friend' in order to achieve strict glycemic control. Whereas patients can also perceive SMBG as a 'foe'. They primarily seek a personal balance between achieving glycemic control and quality of life, leading them to deliberately make other choices regarding SMBG performance than was recommended. Gaining insight and discussing all factors affecting SMBG will help professionals and patients come to mutually agreed goals and to tailor the performance of SMBG to the individual patient. This should result in a more optimal use of SMBG, an improved quality of life, and improved clinical parameters.

Adherence to Glycemic Monitoring in Diabetes

“…7,[20][21][22][23][24] However, despite the evidence supporting the role of glucose monitoring in better patient health outcomes, patient-reported barriers to SMBG are common, span psychological (ie, frustration, distress, fear), social (ie, workplace barriers, peer relations), and financial (ie, cost of supplies) concerns, 12,13,25 and likely contribute to adherence problems. As such, clinical research has worked toward developing interventions that help to minimize barriers and improve patients' adherence to SMBG.…”

“…[4][5][6][7][8][9][10] Multiple barriers may exist to effective blood glucose monitoring. [10][11][12][13] However, there are also a few promising behavioral interventions which have specifically targeted blood glucose monitoring, particularly in patients with T1DM. [14][15][16][17][18][19] While many of these studies present only preliminary results, some of the strategies incorporated in these interventions may be immediately deployable in a clinic setting and should be considered for future intervention trials.…”

Self-Monitoring in Diabetes: When and How Much?

“…It is interesting and surprising that something so simple can offer the T1DM patient the ability to manage alone many situations that everyday life presents. A recent study investigating the patient's perspective of SMBG showed that due to a variety of factors, there is a wide variety in the performance of SMBG [78], including the patients' perception, his/her goals, and personal and contextual factors. Patients did not always perceive SMBG as a positive tool, which would have enabled them to achieve good glycemic control.…”

Care demands of children with type 1 Diabetes Mellitus

“…Glycemic monitoring aims to determine the level of glycemic control acquired by the patient, being the best option in the prevention of acute complications (mainly hypoglycemia) and, over time, in the prevention of chronic complications as a result of effective control. 16 In addition to the capillary glycosometer procedure, family members need to incorporate knowledge regarding the signs and symptoms of hypoglycemia and also hyperglycemia:…”