Self-monitoring of blood glucose - Language and financial barriers in a managed care population with diabetes

OBJECTIVE - Self-monitoring of blood glucose (SMBG) is a cornerstone of dia betes care, but little is known about barriers to this self-care practice. RESEARCH DESIGN AND METHODS - This cross-sectional study examines SMBG prac tice patterns and barriers in 44,181 adults with pharmacologically treated diabetes from the Kaiser Permanente Northern California Region who responde d to a health survey (83% response rate). The primary outcome is self-repor ted frequency of SMBG. RESULTS - Although most patients reported some level of SMBG monitoring, 60 % of those with ripe 1 diabetes and 67% of those with type 2 diabetes repor ted practicing SMBG less frequently than recommended by the American Diabet es Association (three to four times daily for type 1 diabetes, and once dai ly for type 2 diabetes treated pharmacologically). Significant independent predictors of nonadherent practice of SMBG included longer time since diagn osis, less intensive therapy, male sex, age, belonging to an ethnic minorit y, having a lower education and neighborhood income, difficulty communicati ng in English, higher out-of-pocket costs for glucometer strips (especially for subjects with lower incomes), smoking, and excessive alcohol consumpti on. CONCLUSIONS - Considerable gaps persist between actual and recommended SMBG practices in this large managed care organization A somewhat reduced SMBG frequency in subjects with linguistic barriers, some ethnic minorities, and subjects with lower education levels suggests the potential for targeted, culturally sensitive, multilingual health education. The somewhat lower fre quency of SMBG among subjects paying higher out-of-pocket expenditures for strips suggests that removal of financial barriers by providing more compre hensive coverage for these costs may enhance adherence to recommendations f or SMBG.