The Study On Self Monitoring Of Blood Glucose (SMBG)Situation, Influence Factors And The Intervention In Patients With Type2Diabetes In Communities

Diabetes has become a serious healthy and social problem in China. Controling blood glucoser level is the first tast in diabetes treatment and SMBG is an effective method to help diabetes patients control blood glucoser level. SMBG can help patients and doctors understand high blood glucose and hypoglycemia to improve blood glucose level and save health costs. Self management is much needed in diabetes treatment and SMBG is very important in self management of diabetes patients. This study was aimed to understanding SMBG situation and influencing factors and evaluating SMBG intervention effects of patients with type2diabetes in communities. There were two parts in the study.Part I The study on SMBG situation and influence factors in patients with type2diabetes in communitiesObjective:Understanding SMBG situation and influencing factors in patients with type2diabetes in communities and evaluating them blood glucose levels.Method:Retrospective survey method was used. The research objects were the patients who had been managed in communities.Results:15.59%patients had portable blood glucose meters and12.25%patients used SMBG. The monitoring frequent of SMBG was4.46times per month.90.91%SMBG patients had self-monitored FPG (2.78per month) while47.27%SMBG patients had self-monitored PPG. The monitoring frequencies of FPG and PPG were2.78per month and1.10per month. The first five reasons of non-SMBG were the high price of blood glucose test strips(83.11%), the high price of the blood glucose meter(77.31%), considering SMBG unnecessary(70.71%), unknowing how to use the portable blood glucose meter(67.81%) and unknowing how to SMBG (55.94%).89.09%patients considered that their portable blood glucose meter operations were completely correct. But this study found that their operations did not meet the standards in the pre-test preparation, blood collection, equipment maintenance and other aspects.82.18%patients went to hospitals to measure blood glucose. The percent of SMBG patients measuring blood glucose in hospitals was70.91%, which was lower than that of non-SMBG patients (83.76%)(χ2=5.440, P=0.020).14.25%patients didn’t measure blood glucose in the3months and the main reason was their unconsidering measuring blood glucose necessary.The positive factors of SMBG included insulin therapy, consciously blood glucose control levels, and anxiety caused by monitoring blood glucose levels not meet the psychological expectations. The negative factors included blood glucose measurements in hospitals, confidences of control blood glucose levels, financial burdens from SMBG and the correctness of SMBG.38.08%patients’ blood glucose levels were up to the control standard. The rate of the SMBG patients was34.55%while that of the non-SMBG patients was38.58%(χ2=0.333, p=0.564).97.56%patients were willing to learn SMBG knowledge including "when to SMBG","the frequency of SMBG","how to use the SMBG results" and "how to record SMBG results" from follow-up doctor (70.82%), lectures (42.98%) and promotional materials (42.32%).85.53%non-SMBG patients were willing to try SMBG, but only12.01%were willing to buy a portable blood glucose meter for SMBG. Part II The intervention study on SMBG in patients with type2diabetes in communitiesObjective:Explore SMBG intervention model of type2diabetic patients in community and evaluating its effects.Method:Community-based intervention test was used.Results:90.84%patients participated in the six-month intervention completely. Both awareness and attitude of patients were improved after intervention, which had statistically significant differences. The percent of SMBG patients rose to20.61%from12.72%after intervention (χ2=5.116, P=0.024).The percent of blood glucose controlled patients rose to46.93%from35.53%after intervention (χ=6.118, P=0.013). The percent of blood glucose controlled patients who accepted insulin therapy rose to44.44%from27.78%(χ2=2.167, P=0.141) while the percent of blood glucose controlled patients who accepted non-insulin therapy rose to47.40%from36.98%(χ2=4.271, P=0.039) after intervention.Conclusions:1. High percent of the patients with type2diabetes in communities were willing to undertake SMBG, but the percent of their SMBG knowledge awareness was low and the percents of their SMBG action was also low and less reasonable.2. The positive factors of SMBG included insulin therapy, consciously blood glucose control levels, and anxiety caused by monitoring blood glucose levels not meet the psychological expectations. The negative factors included blood glucose measurements in hospitals, confidences of control blood glucose levels, financial burdens from SMBG and the correctness of SMBG.3. The patients with type2diabetes in community of SMBG were in poor blood glucose control, which may be related to disease states of Diabetes and non-standard SMBG behaviors.4. The comprehensive interventions including SMBG and diet, exercise and medication could improve the SMBG situations and blood glucose levels of the patients with type2diabetes in communities.Suggestions:1. Suggest to add SMBG intervention into diabetes patients management work in communities to improve the SMBG consciousness, knowelges and skills of diabetes patients and emphasize to use different intervention forms and tools to meet the individual requirements, to implement SMBG intervention combined with diet, exercise and drug therapy, and let the medical staffs paly important roles in the intervention.2. Suggest the government to fine-tune policies to bring the costs of SMBG blood glucose test strips all or partly into the social health insurance in order to help type2diabetic patients managed in communities monitor and control the level of blood glucose better and save a lot of the role of medical fees.