|Year : 2016 | Volume
| Issue : 1 | Page : 28-32
Self-monitoring of blood glucose in Jos, Nigeria
JO Edah1, G Odoh2, CY Kumtap2, OC Onwukeme2, SO Ojo2, UC Okpala2, DB Mwarak2, FH Puepet3
1 Department of Internal Medicine, Endocrinology and Metabolism Unit, Jos University Teaching Hospital, P.M.B. 2076, Jos, Plateau State, Nigeria
2 Department of Internal Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
3 Department of Internal Medicine, Jos University Teaching Hospital; Department of Internal Medicine, University of Jos, Jos, Plateau State, Nigeria
|Date of Web Publication||1-Mar-2016|
J O Edah
Department of Internal Medicine, Endocrinology and Metabolism Unit, Jos University Teaching Hospital, P.M.B. 2076, Jos, Plateau State
Source of Support: None, Conflict of Interest: None
Background: Self-monitoring of blood glucose (SMBG) is considered one of the cornerstones of diabetes care and is an important component of modern therapy for diabetes mellitus.
Methods: This was a descriptive cross-sectional study carried out at the diabetes clinic of Jos University Teaching Hospital (JUTH) and a private specialist clinic in Jos, North central Nigeria. One hundred and eighty patients on treatment for diabetes aged 18 years and above diagnosed to have diabetes but not less than six months were recruited consecutively. Patients on dietary management and patients with Gestational Diabetes Mellitus (GDM) were excluded from the study. Data was obtained using a questionnaire.
Results: Ninety six (53.3%) were males. The mean age was 56 ± 11 years. The median (range) duration of diabetes was 9.0 (3.0 - 12.5). One hundred and eighteen (65.5%) had either secondary or tertiary education with one hundred and three (57.2%) earning less than N500,000 yearly. The prevalence of self monitoring of blood glucose (SMBG) was only 47.8 % with more than 50% not practicing SMBG as recommended by the American Diabetes Association. Factors associated with SMBG include high level of education, high income (>N 1.5 million yearly), long duration of diabetes (≥10 years) and male sex.
Conclusion: The practice of SMBG in our environment is suboptimal with those practicing it not doing it as recommended. Hence, increased awareness and education of patients with diabetes should be promoted among those who do not practice SMBG and those who do not practice it as recommended.
Keywords: Airway, cardiovascular system, chronic fluorosis, endocrine system, skeleton, spinal anaesthesia, teeth
|How to cite this article:|
Edah J O, Odoh G, Kumtap C Y, Onwukeme O C, Ojo S O, Okpala U C, Mwarak D B, Puepet F H. Self-monitoring of blood glucose in Jos, Nigeria. J Med Trop 2016;18:28-32
|How to cite this URL:|
Edah J O, Odoh G, Kumtap C Y, Onwukeme O C, Ojo S O, Okpala U C, Mwarak D B, Puepet F H. Self-monitoring of blood glucose in Jos, Nigeria. J Med Trop [serial online] 2016 [cited 2019 Aug 20];18:28-32. Available from: http://www.jmedtropics.org/text.asp?2016/18/1/28/172106
| Introduction|| |
Self-monitoring of blood glucose (SMBG) is considered one of the cornerstones of diabetes care since patients' education and participation are emphasized in the management of diabetes mellitus.,, It is also an important component of modern therapy for diabetes mellitus. SMBG, though costly is useful for achieving and maintaining near-normal blood glucose levels, providing feedback to the health care providers and the patient regarding therapeutic effectiveness, helping patients adjust insulin dosages, diet, exercise regimens, and aiding in the detection and prevention of asymptomatic hypoglycemia and extreme hyperglycemia., The goal of SMBG is to collect detailed information about blood glucose level at many time points to enable maintenance of a more constant glucose level by more precise regimens. Self-monitoring among patients with Type 1 diabetes and pharmacologically treated Type 2 diabetes is associated with lower HbA1c levels. It is recommended by the American Diabetes Association (ADA) to be done three to four times in a day in patients with Type 1 diabetes and once a day in pharmacologically treated patients with Type 2 diabetes. However, most persons with diabetes do not use SMBG, or if they do, they do not follow recommended guidelines., The reliability of the use of glucose meters in monitoring glucose levels has been established in Nigeria. Despite its relevance to diabetes self-management and the significant health care cost associated with SMBG, relatively little is known about current practice, pattern and barriers associated with SMBG. Even though our patients are encouraged to monitor their blood glucose levels at home, little is known about the practice and pattern of SMBG in this environment. We, therefore, studied the prevalence and pattern of SMBG as well as the factors associated with SMBG among patients with diabetes mellitus in Jos, Nigeria.
| Materials and Methods|| |
This descriptive cross-sectional study was carried out at the Diabetes Clinic of Jos University Teaching Hospital and a Diabetes Screening Centre, Apex Clinic in Jos, North Central Nigeria. The study was conducted between September and December 2014. One hundred and eighty patients with diabetes, aged 18 years and above being treated pharmacologically who consented to the study were recruited consecutively. Patients diagnosed with diabetes for < 6 months, and patients diagnosed with gestational diabetes were excluded. Data collected using a questionnaire included demographics, level of education, duration of diabetes, type of treatment received, yearly income, and knowledge and usage of SMBG. In this study, SMBG is defined as anyone who monitors his/her glucose levels at home irrespective of the frequency.
Statistical analysis was done using Epi InfoTM statistical soft ware package version 3.5.3 developed by Center for disease control 1600 Clifton Rd. Atlanta, GA 30333 USA. Continuous variables were expressed as means ± standard deviation (SD), whereas categorical variables were expressed as proportions. Chi-square test was used to compare categorical variables. Where the expected frequency of a cell was < 5, Fisher's exact test was used. Univariate and multivariate analyses were done to determine factors associated with SMBG. In all cases, P < 0.05 was considered as statistically significant.
This study was approved by the Human Research Ethics Committee of the Jos University Teaching Hospital. Information concerning all participants was treated with confidentiality. Patients were educated appropriately.
| Results|| |
A total of 180 persons with diabetes mellitus participated in this study. The mean age (SD) of the study population was 56 ± 11 years. There were 43 (23.9%) elderly persons aged 65 years and above with those aged 45–64 years being the majority (111 [61.7%]). The mean age (SD) of females was 56 ± 11 and that of the males was 56 ± 11 with no significant statistical difference ( P = 0.86). There were 96 (53.3 %) males in the study with the male to female ratio being 1.1:1. Most of the study population (49.4 %) had tertiary education, whereas 16.1% had no formal education. Duration of diabetes ranged from 6 months to 37 years with the median (range) being 9.0 (3.0– 12.5). The majority of the study population 65.0% had diabetes for between 6 months to 10 years. One hundred and three (57.2 %) of the study population earned < N500,000 (2513 USD) with 23 (12.8%) earning more than N1.5 million (7541 USD) yearly. Only 14 (7.8 %) of the study population took alcohol with none taking in significant quantity. Most of the study population (98.9%) had Type 2 diabetes. More than half of the study, population (76.1 %) were on oral hypoglycemic agents (OHAs) only with six (3.3%) on insulin (premix 30/70 combination of regular and isophane insulin) alone and 37 (20.6%) on both insulin and OHAs [Table 1].
|Table 1: Sociodemographic and clinical characteristics of the study population|
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The majority (85.6 %) of the study population were aware the importance of SMBG but only 86 (47.8%) practiced this (all of which have Type 2 diabetes). Of these 41 (47.7%) checked their glucose level as recommended (once in a day) while six (7.0%) checked twice a day with one person (1.2%) checking it three times a day. Thirty-eight patients (44.2%) practiced it less frequently than as recommended by the ADA.
Univariate analysis shows the level of education; yearly income and duration of diabetes were associated with SMBG [Table 2]. On multivariate analysis, independent factors associated with SMBG include long duration of diabetes, higher levels of education, high income, and male sex [Table 3].
|Table 2: Univariate analysis showing factors associated with nonutilisation of SMBG|
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| Discussion|| |
The prevalence of SMBG in this study was 47.8%. This is similar to what was found in Spain where they found a prevalence of 50.4% in noninsulin treated Type 2 diabetes patients. A similar prevalence (52%) was also found in the United States of America (USA). The prevalence in this study is, however, higher than what was found in some studies in Nigeria ranging from 11% to 27%,, and in Malaysia where a prevalence of 15.3% was reported. This may be because, this study recruited patients from a teaching hospital, as well as a private specialist hospital where education on SMBG may be optimal compared to the other studies carried out in government-owned hospitals. It is, however, less than what was found in Norway  and the USA., In Norway, 70% was found while in the USA 62% and 75% were found in two different studies. This high prevalence in Norway may be due to the free strips provided to patients in this country since the country of residence influences SMBG. The high prevalence in the USA may be because the test strips and the meters are incorporated in the health insurance scheme.
The pattern of practice of SMBG in this study was less optimal than what is recommended by the ADA. Forty-four percent of those who practiced SMBG do it less frequently than what ADA recommends. This is in agreement with other studies in Nigeria,, Asia, and America.,, Seven (8.2%) persons, however, practice it more frequently than the recommendations by ADA. This is a health economics concern which puts more burdens on these patients. The inadequate practice of SMBG may be as a result of inadequate education on SMBG and the cost of test strips.
Factors associated with SMBG in this study included higher level of education, high income (> N1.5 million yearly), male sex and long duration of diabetes, suggesting that low level of education, low income, female sex, and short duration of diabetes are barriers to SMBG. This is corroborated by other studies where a high level of education,, high income,, and long duration of diabetes  are found to be associated with SMBG.
It is known that SMBG is costly which is mostly from the test strips.  This has been shown to be a major burden for patients with limited economic resources. In this study, persons earning > N1.5 million (7541 USD) yearly were found to be independently associated with SMBG suggesting that low-income (< N500,000 [2513 USD] yearly) is a barrier to SMBG.
Persons with a high level of education (at least secondary education) were found to be independently associated with SMBG in this study. This is corroborated by other studies., SMBG requires patients with diabetes to be competent and confident in their ability to carry out glucose testing and interpret its results to guide lifestyle choices and improve outcomes. This can be achieved if these persons are well-educated to understand the process of glucose testing. Persons that have no formal or low level of education, however, will require repeated education and gentle guidance for them to be confident and competent in this. This, therefore, implies that health caregivers should be patient with this group of people while giving education on SMBG. They will also need constant reminders during each clinic visit. Additionally, with a high level of education, one is likely to get a job with better income and the likelihood of practicing SMBG.
The long duration of diabetes (≥10 years) was also found to be independently associated with SMBG in this study. This is consistent with other studies., This may imply that these patients must have been educated on SMBG over the years with some “experience” and now practice it thereby emphasizing the importance of repeated education and constant reminders.
Male sex was also a factor found in this study to be associated with SMBG. The finding in this study may be because men are more economically empowered in this environment than women which enable men to practice SMBG more than the women. This means that women empowerment will go a long way to enable them practice SMBG. However, in the USA, Karter et al. found male sex to be associated with nonadherence to recommended practice of SMBG.
The study had some limitations. The data were self-reported and so may not reflect actual performance as patients may report SMBG in a way that they think is acceptable. Additionally, it is a hospital based study, so it cannot be generalized to the public.
| Conclusion|| |
This study has revealed that the prevalence of SMBG among our patients is suboptimal with over 50% of patients not practicing it as recommended. We also found factors associated with SMBG to include high income, high level of education, long duration of diabetes, and male sex. This suggests that educating patients with diabetes continuously on SMBG is key in ensuring practicing of SMBG. The government should incorporate test strips and glucose meters into the national health insurance scheme which will reduce the burden on these patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
American Diabetes Association. Clinical practice recommendations. Diabetes Care 1998;21 Suppl 1:S1-98.
Lorig KR, Sobel DS, Stewart AL, Brown BW Jr, Bandura A, Ritter P, et al.
Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: A randomized trial. Med Care 1999;37:5-14.
American Diabetes Association (ADA). Standards of medical care in diabetes-2014. Diabetes Care 2014;35 Suppl 1:S11-63.
Evan MB. Self monitoring of blood glucose: The basics. Clin Diabetes 2002;20:45-7.
American Diabetes Association. Clinical practice recommendations. Diabetes Care 1997;20 Suppl 1:S1-70.
Karter AJ, Ackerson LM, Darbinian JA, D'Agostino RB Jr, Ferrara A, Liu J, et al.
Self-monitoring of blood glucose levels and glycemic control: The Northern California Kaiser Permanente Diabetes registry. Am J Med 2001;111:1-9.
Karter AJ, Ferrara A, Darbinian JA, Ackerson LM, Selby JV. Self-monitoring of blood glucose: Language and financial barriers in a managed care population with diabetes. Diabetes Care 2000;23:477-83.
Unachukwu CN, Young EE, Uchenna DI. Self blood glucose monitoring among diabetic patients in Port Harcourt, Nigeria. Afr J Diabetes Med 2011;19:19-20.
Udezue EO, Ezeoke AC, Oli JM. Use of a portable glucose meter in a Nigerian diabetic clinic. Trop Geogr Med 1989;41:141-5.
Cano-Blanquer D, Cervera-Casino P, Peiró-Moreno S, Mateu-García M, Barreda-Aznar A; Grupo de Estudio de la Automonitorización Glucémica. Prevalence and associated factors in self-monitoring of blood glucose in noninsulin-treated type 2 diabetes patients in the Valencia Community, Spain. Rev Esp Salud Publica 2013;87:149-63.
Vincze G, Barner JC, Lopez D. Factors associated with adherence to self-monitoring of blood glucose among persons with diabetes. Diabetes Educ 2004;30:112-25.
Eregie A, Unadike BC. Factors associated with self-monitoring of glycaemic control among persons with diabetes in Benin city, Nigeria. Afr J Diabetes Med 2011;19:14.
Nwankwo CH, Nandy B, Nwankwo BO. Factors influencing diabetes management outcome among patients attending government health facilities in South East Nigeria. Int J Trop Med 2010;5:28-36.
Mastura I, Mimi O, Piterman L, Teng CL, Wijesinha S. Self-monitoring of blood glucose among diabetes patients attending government health clinics. Med J Malaysia 2007;62:147-51.
Kjome RL, Granas AG, Nerhus K, Roraas TH, Sandberg S. The prevalence of self-monitoring of blood glucose and costs of glucometer strips in a nationwide cohort. Diabetes Technol Ther 2010;12:701-5.
Franciosi M, Pellegrini F, De Berardis G, Belfiglio M, Cavaliere D, Di Nardo B, et al.
The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: An urgent need for better educational strategies. Diabetes Care 2001;24:1870-7.
American Diabetes Association. Self monitoring of blood glucose in type 2 diabetes-Steps toward consensus. Diabetes Care 2007;30:E105.
Harris MI, Cowie CC, Howie LJ. Self-monitoring of blood glucose by adults with diabetes in the United States population. Diabetes Care 1993;16:1116-23.
Adams AS, Mah C, Soumerai SB, Zhang F, Barton MB, Ross-Degnan D. Barriers to self-monitoring of blood glucose among adults with diabetes in an HMO: A cross sectional study. BMC Health Serv Res 2003;3:6.
Yeaw J, Lee WC, Aagren M, Christensen T. Cost of self-monitoring of blood glucose in the United States among patients on an insulin regimen for diabetes. J Manag Care Pharm 2012;18:21-32.
Hunt LM, Pugh J, Valenzuela M. How patients adapt diabetes self-care recommendations in everyday life. J Fam Pract 1998;46:207-15.
Austin MM. The two skill sets of self monitoring of blood glucose education; the operational and the interpretive. Diabetes Spectr 2013;26:83-90.
[Table 1], [Table 2], [Table 3]