https://diabetes.acponline.org/archives/2013/08/09/2.htm

Patients report emotional factors play big role in glucose self-monitoring, survey suggests

For patients with type 2 diabetes, emotional factors may influence glucose self-monitoring behavior as much or more than practical factors, a new study suggests.


For patients with type 2 diabetes, emotional factors may influence glucose self-monitoring behavior as much or more than practical factors, a new study suggests.

Researchers distributed an anonymous 68-item survey to attendees of a one-day conference for people with diabetes held in seven U.S. urban areas in 2009. Inclusion criteria included having type 2 diabetes for at least 12 months, being at least 18 years old, and being able to read and write in English. The survey aimed to collect data on actual and recommended self-monitoring of blood glucose frequency and perceived obstacles to self-monitoring. Principal component analysis was used to classify 12 obstacles into three types, and regression analyses were then used to examine associations between these three types and self-monitoring behavior. Results were published online July 19 by Diabetic Medicine.

Of the 886 patients included in the final analysis, 64.5% (n=571) were non-insulin users and 35.5% (n=315) were insulin users. Thirty-eight percent of insulin users and 45.9% of non-insulin users said their weekly self-monitoring frequency was less than what was recommended by clinicians. The mean frequency of self-monitoring was 19.2 (± 12.3) times per week for insulin users and 10.0 (± 8.7) for non-insulin users; reports of clinician recommendations averaged 22.2 (± 10.6) tests/week for insulin users and 13.7 (± 9.3) for non-insulin users. Insulin users were more likely than non-insulin users to share results with clinicians (P<0.01).

On analysis, the three main obstacles to self-monitoring were “avoidance” (not wanting to think about the results or about diabetes in general), “pointlessness” (feeling powerless about results) and “burden” (i.e., practical nuisances, such as finding the task too expensive or unpleasant). Higher burden scores weren't associated with any change in self-monitoring behaviors. Results didn't differ by insulin versus non-insulin use.

Avoidance (β= −0.12; P<0.01) and pointlessness (β= −0.15; P<0.001) were significant independent predictors of how often glucose self-monitoring data were shared with a clinician. They also predicted whether or not these data were used to make management adjustments (avoidance: odds ratio [OR], 0.74; P<0.001; pointlessness: OR, 0.75; P<0.01). The direction of these associations indicated high avoidance and pointlessness scores were associated with less self-monitoring and data sharing.

“Emotional obstacles to self-monitoring [avoidance and pointlessness] are more critical than day-to-day behavioral obstacles [burden]…,” the authors wrote. Clinicians should address these obstacles directly with patients by not appearing to “blame” patients for high glucose values, and by taking time to review self-monitoring results so patients feel their effort is worthwhile, the authors said.

Study limitations include its generalizability, given that subjects were motivated to attend a one-day diabetes conference. Also, data were derived from patient self-reports, and the pool of obstacles was fairly small and may not have captured other aspects of self-monitoring about which patients have concerns, the authors wrote.