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Self-monitoring of blood glucose (SMBG) has been advocated as an integral part of diabetes care that can reassure and empower patients and improve glycosylated hemoglobin, and has been linked to better outcomes.1,2 The purpose of this study was to compare those who conduct SMBG as recommended and those who do not with respect to patient demographics, self-care behaviors, barriers to SMBG, and purchase of blood glucose testing supplies. After institutional review board approval, from four Iowa Research Network rural offices, 48 patients consented to participate and 42 were enrolled in the study, completed a questionnaire, and had medical record and insurance claims reviewed.
Participants' mean age was 55 years, and all were Caucasian. There were no significant differences by age category, gender, marital status, or education when comparing those who test blood glucose less than 90% of the time recommended versus those greater than or equal to 90% of the time recommended or when compared <1 time/day versus ≥1 time/day. Individuals with higher income were more likely to report testing <90% of the time and to report testing blood glucose <1 time/day (see Table 1).
Twenty (49%) participants reported testing their blood glucose one or more times a day, while seven (17%) had their blood glucose tested only when they were at their physician's office. Thirty-five respondents reported a mean satisfaction of 3.31 (on a 1 to 5 scale) with testing their blood glucose, and six were not satisfied with their blood glucose testing. Respondents reported on barriers for SMBG. Being too busy and caring more about other things were the biggest barriers for those not conducting SMBG as recommended (see Table 1).
Recommendations for SMBG were not noted in any medical record. Persons with high SMBG adherence were significantly lower in weight and had a lower body mass index (see Table 1).
From the insurance data, 14 (33%) subjects did not purchase a glucometer or test strips a year before or after the study consent date. Fifteen (36%) subjects purchased test strips a year before the consent data, and 16 (38%) subjects purchased test strips the year after (some were the same person in each year). Test strips were usually purchased in boxes of 100. For those who purchased test strips, on average, approximately 100 strips were purchased per year.
Based on the insurance data, the subjects (15 subjects the year before study enrollment and 16 the year after) who purchased testing supplies paid a mean co-pay of $107.00 for their test strips. No significant difference was found between years for the allowed insurance coverage and the patient liability. Persons with high SMBG adherence purchased more test strips over the 2-year period than those with lower adherence (see Table 1).
Education of patients should include blood glucose goals and guidelines for patients to follog regarding adjusting their medication, diet, and exercise. Insurance claims data seems to provide the most accurate available depiction of test strips purchased, followed by subject self-repor, and then medical record progress notes.
This work was supported by the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (R21 HS014859).