Aj. Karter et al., Self-monitoring of blood glucose - Language and financial barriers in a managed care population with diabetes, DIABET CARE, 23(4), 2000, pp. 477-483
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.