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Impact of blood glucose monitoring on diabetic control: Obstacles and interventions

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Abstract

Despite frequent use in the management of diabetes mellitus, self-monitoring of blood glucose (SMBG) is not achieving its potential therapeutic impact. Among the behavioral factors which may interfere with the improvement of diabetic control through SMBG are noncompliance and inadequate utilization of obtained blood glucose data. This paper reviews the research concerning these issues, including estimates of the prevalence and clinical significance of each of these limiting factors and an evaluation of assessment and intervention strategies which have been investigated. The methodological problems encountered in attempts to demonstrate that SMBG behaviors affect diabetic control are discussed. Although the existing research literature provides very weak evidence linking SMBG behaviors and diabetic control, the author asserts that it is premature to conclude that such relationships cannot be established and maintained.

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References

  • American Diabetes Association (1987). Consensus statement on self-monitoring of blood glucose.Diabetes Care 10: 95–99.

    Google Scholar 

  • Baker, J., Metcalf, P. Holdaway, I., and Johnson, R. (1985). Serum fructosamine concentration as a measure of blood glucose control.Br. Med. J. 290: 352–355.

    Google Scholar 

  • Belmonte, M., Schiffrin, A., Dufresne, J., Suissa, S., Goldman, H., and Polychronakos, C. (1988). Impact of SMBG on control of diabetes as measured by HbA-1: A 3 yr. survey of a juvenile IDDM clinic.Diabetes Care 11: 484–488.

    PubMed  Google Scholar 

  • Bloomgarden, Z. T., Karmally, W., Metzger, M. J., Brothers, M., Nechemias, C., Bookman, J., Faierman, D., Ginsberg-Fellner, F., Rayfield, E., and Brown, W. (1987). Randomized controlled trial of diabetic patient education: Improved knowledge without improved metabolic status.Diabetes Care 10: 263–272.

    PubMed  Google Scholar 

  • Boden, G., Master, R. W., Gordon, S. S., Shuman, C. R., and Owen, O. E. (1980). Monitoring metabolic control in diabetic outpatients with glycosylated hemoglobin.Ann. Intern. Med. 92: 357–360.

    PubMed  Google Scholar 

  • Bubb, J., Delamater, A. M., Smith, J., and White, N. (1987). Effects of self management training (SMT) on metabolic control of children with newly diagnosed diabetes: A one year followup.Diabetes 36 (Suppl. 1): 86A.

    Google Scholar 

  • Carney, R. M., Schechter, K., Homa, M., Levandoski, L., White, N., and Santiago, J. (1981). The effects of blood glucose testing versus urine glucose testing on the metabolic control of insulin-dependent diabetic children.Diabetes Care 4: 378–380.

    Google Scholar 

  • Carney, R. M., Schechter, K., and Davis, T. (1983). Improving adherence to blood glucose testing in insulin-dependent diabetic children.Behav. Ther. 14: 247–254.

    Google Scholar 

  • Clarke, W. L., Snyder, A., and Nowacek, G. (1985). Outpatient pediatric diabetes I: Current clinical practices.J. Chron. Dis. 38: 85–90.

    PubMed  Google Scholar 

  • Clarke, W. L., Cox, D. J., Gonder-Frederick, L. M., Carter W., and Pohl, S. (1987). Evaluating the clinical accuracy of systems for self-monitoring of blood glucose.Diabetes Care 10: 622–628.

    PubMed  Google Scholar 

  • Clarson, C., Daneman, D., Frank, M., Link, J., Perlman, K., and Ehrlich, R. M. (1985). Self-monitoring of blood glucose: How accurate are children with diabetes at reading Chemstrip BG?Diabetes Care 8: 354–358.

    PubMed  Google Scholar 

  • Cox, D. J., Gonder-Frederick, L. M., Phol, S., and Pennebaker, J. (1983). Reliability of symptom-blood glucose relationships among insulin-dependent adult diabetics.Psychosom. Med. 45: 357–360.

    PubMed  Google Scholar 

  • Cox, D. J., Clarke, W. L., and Gonder-Frederick, L. M. (1985). Accuracy of perceiving blood glucose in IDDM.Diabetes Care 8: 529–536.

    PubMed  Google Scholar 

  • Cox, D. J., Herrman, J., and Gonder-Frederick, L. M. (1987a). Training Type I patients to accurately estimate blood glucose (BG) levels.Diabetes 36 (Suppl. 1): 87A.

    Google Scholar 

  • Cox, D. J., Irvine, A., Gonder-Frederick, L. M., Nowacek, G., and Butterfield, J. (1987b). Fear of hypoglycemia: Quantification, validation and utilization.Diabetes Care 10: 617–621.

    PubMed  Google Scholar 

  • Daneman, D., Epstein, L. H., Siminerio, L., Beck, S., Farkas, G., Figueroa, J., Becker, D. J., and Drash, A. L. (1982). Effects of enhanced conventional therapy on metabolic control in children with insulin-dependent diabetes mellitus.Diabetes Care 5: 472–478.

    PubMed  Google Scholar 

  • DCCT Research Group (1987). Diabetes Cobtrol and Complications Trial: Results of feasibility study.Diabetes Care 10: 1–9.

    Google Scholar 

  • Delameter, A. M., Davis, S. G., Bubb, J., and Smith, J. (1987). Utilization of self blood glucose monitoring (SBGM) data by adolescents with diabetes.Diabetes 36 (Suppl 1): 17A.

    Google Scholar 

  • Delamater, A. M., Kurtz, S. M., White, N. H., and Santiago, J. V. (1988). Effects of social demand on reports of self-monitored blood glucose in adolescents with Type I diabetes mellitus.J. Appl. Social. (in press).

  • Diabetes Care (1981). Symposium: Blood glucose self monitoring.Diabetes Care 4: 392–426.

    Google Scholar 

  • Diabetes Care (1983).Diabetes Care 6: 529–547.

    Google Scholar 

  • Dunn, S. M., Bryson, J. M., Hoskins, P. L., Alford, J. B., Handelsman, C. J., and Turtle, J. (1984). Development of the Diabetes Knowledge Test: Forms DKNA, DKNB and DKNC.Diabetes Care 7: 36–41.

    PubMed  Google Scholar 

  • Eastman, B. G., Johnson, S. B., Silverstein, J. P., Spillar, R. P., and McCallum, M. (1983). Understanding of hypo- and hyperglycemia by youngsters with diabetes and their parents.J. Pediat. Psychol. 8: 229–243.

    Google Scholar 

  • Epstein, L. H., Coburn, P., Drash, A., and Siminerio, L. (1980). Measurement and modification of the accuracy of urine glucose determinations in insulin-dependent diabetic children.Diabetes Care 3: 535–536.

    PubMed  Google Scholar 

  • Epstein, L. H., Figueroa, J., Farkas, G., and Beck, S. (1981a). The short term effects of feedback on accuracy of urine glucose determinations in insulin-dependent diabetic children.Behav. Ther. 12: 560–564.

    Google Scholar 

  • Epstein, L. H., Beck, S., Figueroa, J., Farkas, G., Kazdin, A. E., Daneman, D., and Becker, D. J. (1981b). The effects of targeting improvement in urine glucose on metabolic control in children with insulin-dependent diabetes.J. Appl. Behav. Anal. 14: 365–375.

    PubMed  Google Scholar 

  • Flavin, K., Gavin, J., Houston, C., and Cole, K. (1987). Assessment of clinical diabetes management by physicians.Diabetes 36 (Suppl. 1): 31A.

    Google Scholar 

  • Freund, A., Johnson, S. B., Rosenbloom, A., Alexander, B., and Hansen, C. A. (1986). Subjective symptoms, blood glucose estimation and blood glucose concentration in adolescents with diabetes.Diabetes Care 9: 236–243.

    PubMed  Google Scholar 

  • Gardner, D., Eastman, B., Mehl, T., and Merimee, T. (1985). Effect of psychosocial factors on success in a program of self glucose monitoring.Diabet. Res. 2: 89–93.

    Google Scholar 

  • Garrard, J., Joynes, J. O., Mullen, L., McNeil, L., Mensing, C., Feste, C., and Etzwiler, D. D. (1987). Psychometric study of patient knowledge test.Diabetes Care 10: 500–509.

    PubMed  Google Scholar 

  • Glasgow, R. E., and Toobert, D. J. (1988). Social environment and regimen adherence among Type II diabetic patients.Diabetes Care 11: 377–386.

    PubMed  Google Scholar 

  • Glasgow, R. E., McCaul, K. D., and Schafer, L. (1987). Self care behaviors and glycemic control in Type I diabetes.J. Chron. Dis. 40: 399–412.

    PubMed  Google Scholar 

  • Golden, M. P., Gray, D. L., and Marrero, D. G. (1985). Patient vs. physician control of insulin dose adjustment: An exploratory study.J. Pediat. Endocrinol. 1: 145–149.

    Google Scholar 

  • Gonder-Frederick, L. M., and Cox, D. J. (1986). Behavioral response to perceived hypoglycemia: A report and some suggestions.Diabetes Educ. 12: 105–109.

    PubMed  Google Scholar 

  • Gonder-Frederick, L. M., Cox, D. J., Bobbitt, S., and Pennebaker, J. (1986). Blood glucose symptom beliefs of diabetic patients: Accuracy and implications.Health Psychol 5: 327–341.

    PubMed  Google Scholar 

  • Gonder-Frederick, L. M., Clarke, W. L., and Snyder, A. (1987). Ability to perceive hypo- and hyperglycemia by IDDM children children and their parents.Diabetes 36 (Suppl. 1): 108A.

    Google Scholar 

  • Gonder-Frederick, L. M., Julian, D. M., Cox, D. J., Clarke, W. L., and Carter, W. (1988). Self-measurement of blood glucose: Accuracy of self reported data and adherence to recommended regimen.Diabetes Care 11: 579–585.

    PubMed  Google Scholar 

  • Hess, G. E., and Davis, W. K. (1983). The validation of a diabetes patient knowledge test.Diabetes Care 6: 591–596.

    PubMed  Google Scholar 

  • Hirsch, I., Matthews, M., Rawlings, J., Broughton, J., Breyfogle, J., Simonds, J., Kossoy, K., England, J., Weidmeyer, H., Little, R., and Goldstein, D. (1983). Home capillary blood glucose monitoring (HBGM) for diabetic youth: A one year followup of 98 patients.Diabetes 32 (Suppl. 1): 16A.

    Google Scholar 

  • Hulka, B., Kupper, L., Cassell, J., and Mayo, F. (1975). Doctor-patient communication and outcome among diabetic patients.J. Commun. Health 1: 15–27.

    Google Scholar 

  • Ingersoll, G., Orr, D., Herrold, A., and Golden, M. (1986). Cognitive maturity and self management among adolescents with insulin-dependent diabetes mellitus.J. Pediat. 108: 620–623.

    PubMed  Google Scholar 

  • Jenkins, C., Levitsky, L., and Thorp, F. (1987). The telephone call-in hour as a management technique for the diabetic child.Diabetes 36 (Suppl. 1): 143A.

    Google Scholar 

  • Johnson, S. B. (1987). Measuring compliance-control relationships in juvenile diabetes: Potential problems and possible solutions. Presented at American Psychological Association, Division 12 Midwinter Meeting, Honolulu.

  • Johnson, S. B., Pollak, T., Silverstein, J., Rosenbloom, A., Spillar, R., McCallum, M., and Harkavy, J. (1982). Cognitive and behavioral knowledge about insulin-dependent diabetes among children and parents.Pediatrics 69: 708–713.

    PubMed  Google Scholar 

  • Johnson, S. B., Silverstein, J., Rosenbloom, A., Carter, R., and Cunningham, W. (1986). Assessing daily management in childhood diabetes.Health Psychol. 5: 545–564.

    PubMed  Google Scholar 

  • Johnson, S. B., Silverstein, J., Rosenbloom, A., Hansen, C., Carter, R., and Cunningham, W. (1987). Compliance and health status in childhood diabetes: A preliminary cross-sectional investigation. Unpublished manuscript, University of Florida, Gainesville.

    Google Scholar 

  • Korhonen, T., Huttunen, J. K., Aro, A., Hentinen, M., Ihalainen, O., Majander, H., Siitonen, O., Uusitupa, M., and Pyorala, K. (1986). A controlled trial of the effects of patient education in the treatment of insulin-dependent diabetes.Diabetes Care 9: 256–261.

    Google Scholar 

  • Langer, O., and Mazze, R. S. (1986). Diabetes in pregnancy: Evaluating self-monitoring performance and glycemic control with memory-based reflectance meters.Am. J. Obstet. Gynecol. 155: 635–637.

    PubMed  Google Scholar 

  • Mann, N. P., Noronha, J. L., and Johnston, D. I. (1984). A prospective study to evaluate the benefits of long term self monitoring of blood glucose in diabetic children.Diabetes Care 7: 322–326.

    PubMed  Google Scholar 

  • Marteau, T., Johnston, M., Baum, J., and Bloch, S. (1987). Goals of treatment in diabetes: A comparison of doctors and parents of children with diabetes.J. Behav. Med. 10: 33–49.

    PubMed  Google Scholar 

  • Mazze, R. S., Shamoon, H., Pasmantier, R., Lucido, D., Murphy, J., Hartmann, K., Kuykendall, V., and Lopatin, W. (1984). Reliability of blood glucose monitoring by patients with diabetes mellitus.Am. J. Med. 77: 211–217.

    PubMed  Google Scholar 

  • Mazze, R. S., Pasmantier, R., Murphy, J., and Shamoon, H. (1985). Self-monitoring of capillary blood glucose: Changing the performance of individuals with diabetes.Diabetes Care 8: 207–213.

    PubMed  Google Scholar 

  • Mazzuca, S. A., Weinberger, M., Kurpius, D., Froehle, T., and Heister, M. (1983). Clinician communication associated associated with diabetic patients' comprehension of their therapeutic regimen.Diabetes Care 6: 347–350.

    PubMed  Google Scholar 

  • Mazzuca, S. A., Moorman, N., Wheeler, M., Norton, J., Fineberg, N., Vinicor, F., Cohen, S., and Clark, C. (1986). The Diabetes Education Study: A controlled trial of the effects of diabetes patient education.Diabetes Care 9: 1–10.

    PubMed  Google Scholar 

  • Mehl, T., Wenzel, S., Russell, B., Gardner, D., and Merimee, T. (1983). Comparison of two indices of glycemic control in diabetic subjects; Glycosylated serum protein and hemoglobin.Diabetes Care 6: 34.

    PubMed  Google Scholar 

  • Paradis, J., Havrankova, J., Lepage, R., Rivard, C., Belanger, R., D'Amour, P., Matte, R., and Ste. Marie, L. G. (1987). Accuracy of SMBG: Comparison of patient generated measurements and laboratory determination of glucose in dried blood on filter paper.Diabetes 36 (Suppl. 1): 33A.

    Google Scholar 

  • Pennebaker, J. W., Cox, D. J., Gonder-Frederick, L. M., Wunsch, M. G., Evans, W. S., and Pohl, S. (1981). Physical symptoms related to blood glucose in insulin-dependent diabetics.Psychosom. Med. 43: 489–500.

    PubMed  Google Scholar 

  • Peyrot, M., and Rubin, R. R. (1988). Insulin self regulation predicts better glycemic control.Diabetes 37: (Suppl. 1): 53A.

    Google Scholar 

  • Phillips, R., Sanchez, J., Pedromingo, A., and Fernandez-Cruz, A. (1987). An evaluation of the credibility of blood glucose results reported by diabetic patients through the use of a reflectance meter with memory.Diabetes 36 (Suppl. 1): 63A.

    Google Scholar 

  • Retting, B., Shrauger, D., Recker, R., Gallagher, T., and Wiltse, H. (1986). A randomized study of the effects of a home diabetes education program.Diabetes Care 9: 173–178.

    PubMed  Google Scholar 

  • Romm, F., and Hulka, B. (1979). Care process and patient outcome in diabetes mellitus.Med. Care 17: 748–757.

    PubMed  Google Scholar 

  • Schafer, L. C., Glasgow, R. E., and McCaul, K. D. (1982). Increasing the adherence of diabetic adolescents.J. Behav. Med. 5: 353–362.

    Google Scholar 

  • Schafer, L. C., Glasgow, R. E., McCaul, K. D., and Dreher, M. (1983). Adherence to IDDM regimens: Relationship to psychosocial variables and metabolic control.Diabetes Care 6: 493–498.

    PubMed  Google Scholar 

  • Schafer, L. C., McCaul, K. D., and Glasgow, R. E. (1986). Supportive and non-supportive family behaviors: Relationship to adherence and metabolic control in persons with Type I diabetes.Diabetes Care 9: 179–185.

    PubMed  Google Scholar 

  • Schiffrin, A., and Belmonte, M. (1982). Multiple daily self glucose monitoring: Its essential role in long term glucose control in insulin-dependent diabetic patients treated with pump and multiple subcutaneous injections.Diabetes Care 5: 479–484.

    PubMed  Google Scholar 

  • Shamoon, H., Mazze, R., Pasmantier, R., Lucido, D., and Murphy, J. (1986). Assessment of long term glycemia in Type I diabetes using multiple blood glucose values stored in a memory-containing reflectometer.Am. J. Med. 80: 1086–1092.

    PubMed  Google Scholar 

  • Skyler, J. S. (1988). Conclusions.Diabetes Spectrum 1: 118–120.

    Google Scholar 

  • Smith, M. A., Greene, S., Kuykendall, V., and Baum, J. (1985). Memory blood glucose reflectance meter and computer: A preliminary report of its use in recording and analyzing blood glucose data measured at home by diabetic children.Diabet. Med. 2: 265–268.

    PubMed  Google Scholar 

  • Vargas, J. S. (1972).Writing Worthwhile Behavioral Objectives, Harper and Row, New York.

    Google Scholar 

  • Wilson, D. P., and Endres, R. K. (1986). Compliance with blood glucose monitoring in children with Type I diabetes mellitus.J. Pediat. 108: 1022–1024.

    PubMed  Google Scholar 

  • Wing, R., Epstein, L. H., Lamparski, D., Hagg, S., Nowalk, M. P., and Scott, N. (1984). Accuracy in estimating fasting blood glucose levels by patients with diabetes.Diabetes Care 7: 476–478.

    PubMed  Google Scholar 

  • Wing, R., Lamparski, D., Zaslow, S., Betschart, J., Siminerio, L., and Becker, D. (1985a). Frequency and accuracy of self monitoring of blood glucose in children: Relationship to glycemic control.Diabetes Care 8: 214–218.

    PubMed  Google Scholar 

  • Wing, R., Epstein, L. H., Nowalk, M., Scott, N., and Koeske, R. (1985b). Compliance to self monitoring of blood glucose: A marked item technique compared with self report.Diabetes Care 8: 456–460.

    PubMed  Google Scholar 

  • Wing, R., Koeske, R., New, A., Lamparski, D., and Becker, D. (1986). Behavioral skills in self-montoring of blood glucose: Relationship to accuracy.Diabetes Care 9: 330–333.

    PubMed  Google Scholar 

  • Wise, P. H., Dowlatsahi, D., Farrant, S., Fromson, S., and Meadows, K. (1986). Effect of computer-based learning on diabetes knowledge and control.Diabetes Care 9: 504–508.

    PubMed  Google Scholar 

  • Wysocki, T., Bellando, J., and Netherton, S. (1987). Assessment of age-related changes in diabetes-specific skills. Presented at Society of Behavioral Medicine, Washington, D.C., March.

  • Wysocki, T., Green, L., and Huxtable, K. (1988). Behavioral application of reflectance meters with memory in juvenile diabetes.Diabetes 37 (Suppl. 1): 18A.

    Google Scholar 

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  1. Ohio State University College of Medicine and Children's Hospital, Columbus, Ohio

    Tim Wysocki

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Wysocki, T. Impact of blood glucose monitoring on diabetic control: Obstacles and interventions. J Behav Med 12, 183–205 (1989). https://doi.org/10.1007/BF00846550

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