Interviews with 18 Scottish patients   (September 1, 2007)

A very small study has produced some very thought-provoking results. In a report entitled "Self monitoring of blood glucose in type 2 diabetes: longitudinal qualitative study of patients' perspectives", researchers in the UK reported results of their interviews with 18 Scottish patients with type 2 diabetes. The full report is available on-line.

The researchers did repeated in-depth interviews with these patients over four years after their diagnosis. Their analysis revealed three main themes that emerged amongst the interviewees:

1. the role of health professionals,
2. interpreting readings and managing high values, and
3. the ongoing role of blood glucose self monitoring.

They commented that self monitoring decreased over time, and health professionals' behavior seemed crucial in this: participants interpreted doctors' focus on levels of hemoglobin A1c and lack of perceived interest in meter readings, as indicating that self monitoring was not worth continuing. Some participants saw readings as a proxy measure of good and bad behavior, chastising themselves when readings were high. Some participants continued to find readings difficult to interpret, with uncertainty about how to respond to high readings. Reassurance and habit were key reasons for continuing. There was little indication that participants were using self monitoring to effect and maintain behavior change.

The authors concluded that "Clinical uncertainty about the efficacy and role of blood glucose self monitoring in patients with type 2 diabetes is mirrored in patients' own accounts. Patients tended not to act on their self monitoring results, in part because of a lack of education about the appropriate response to readings. Health professionals should be explicit about whether and when such patients should self monitor and how they should interpret and act upon the results, especially high readings."

These results and comments mirror a theme I've previously discussed: physicians and diabetes teams should explain not just how to test, but what to do with the information -- see my previous discussions Times to check your blood sugar and Why to check your blood sugar.

If you're testing your blood sugar, and you don't have advice on what to do with the results, ask! The reason to check your blood sugar is to allow you to adjust your diabetes program, not just to write numbers down to show the doctor later.