|Year : 2013 | Volume
| Issue : 1 | Page : 54-57
Self monitoring of blood glucose level among diabetic patients in Muscat, Oman: A pilot study
Abdul S Nazmi, Shah A Khan, Dunia A Hadithi
Department of Pharmacy, Oman Medical College, Muscat, Sultanate of Oman
|Date of Web Publication||29-May-2013|
Abdul S Nazmi
Department of Pharmacy, Oman Medical College, PO Box 620, Postal Code - 130, Muscat
Sultanate of Oman
Source of Support: None, Conflict of Interest: None
Introduction: Monitoring of blood glucose (BG) is an important aspect of the diagnosis and management of diabetes. Self monitoring of blood glucose (SMBG) of patients at home can provide patients and physicians with valuable information in the management of diabetes mellitus. Objective: The aim of this pilot study was to assess the awareness, attitude and practice of SMBG among primary care diabetic patients in Muscat region. Materials and Methods: The study was conducted in two phases. In the first phase 140 patients attending diabetes clinics at various health centers in Muscat region were interviewed to identify patients who practice SMBG. In the second phase a closed ended questionnaire containing 10 questions related to demographic characteristics and attitude was self administered to 50 patients recruited from the first phase to generate the data. Results: It was found that only one third of the patients use glucometer to monitor their BG at home. However, majority of the patients were aware of the significance and importance of glucose home monitoring and thus recommended the practice of SMBG to other diabetic patients. Participants acknowledged the role of pharmacist in educating and training the patient about the proper use of glucometers. Patients were convinced with the device performance and pricking finger was not a deterrent, but at the same time the frequency of BG monitoring was poor among the participants. Conclusion: Overall the participants had a positive attitude towards SMBG but there is a room for the improvement among the participants who showed poor frequency of BG monitoring. There is a need to aware and educate the Omani diabetic patients about the importance of SMBG to achieve the desired therapeutic goals.
Keywords: Diabetes mellitus, glucometer, self monitoring of blood glucose
|How to cite this article:|
Nazmi AS, Khan SA, Hadithi DA. Self monitoring of blood glucose level among diabetic patients in Muscat, Oman: A pilot study. Saudi J Health Sci 2013;2:54-7
| Introduction|| |
The prevalence of diabetes mellitus (DM) has increased alarmingly mainly due to the life style changes and obesity factor. As per WHO findings, an estimated 285 million people, corresponding to 6.4% of the world's adult population are suffering from diabetes. This value is further expected to grow to 438 million by year 2030.  Diabetes has emerged as a major and growing health problem in the Sultanate of Oman. Approximately 10% of the Omani population is suffering from this chronic disease  and according to WHO prediction, number of subjects living with diabetes in Oman over the next 20 years will rise from 75,000 in 2000 to 217,000 in 2025. 
Monitoring of blood glucose (BG) is an important aspect of management of this chronic medical condition. The risk of developing complications is greatly reduced if the BG levels are well controlled. SMBG of patients at home can provide patients and physicians with valuable information in the management of DM. It allows patients to participate in their own health care that may be beneficial in controlling BG, thus improving treatment adherence and clinical outcomes. SMBG also assists the physician to recommend, adjust diet and prescribe medications for maintaining appropriate BG control. ,
Data obtained from many previous studies clearly indicate an improved metabolic control among patients when BG was measured at home. ,,, Larger and better designed trials have also shown that SMBG improves glycemic control when the results are used to adjust therapy.  Therefore, type 1 and type 2 diabetic patients are encouraged to use glucometers to monitor their BG levels at home.
This pilot study aimed to assess the awareness, attitude and practice of SMBG among primary care diabetic patients in Muscat region.
| Materials and Methods|| |
A close ended questionnaire was developed to assess the level of awareness among diabetic patients in Muscat governorate of Sultanate of Oman. It was validated for accuracy, language and length by administering it to 3 patients. Patients were assessed with self administered questionnaire to obtain information about their age, gender, type of diabetes, performance of BG measuring device and practice regarding self monitoring of blood glucose (SMBG).
A total of 140 patients attending diabetes clinics at various health centers in Muscat region were identified excluding gestational diabetes. After obtaining the approval from the health centre administration, 140 patients were requested to answer a simple question 'Do you practice SMBG beside their age and gender. Only those patients who self monitored their BG at home were selected and recruited for further study. The goal and objectives of the study were briefly explained to participants and a verbal consent was obtained. A total of 50 completely filled questionnaires were used to generate the data. The data was analyzed statistically by Statistical Package for the Social Sciences (SPSS) version 19.0.
| Results and Discussion|| |
Initially 140 diabetic patients, 67 males (47.85%) and 73 females (52.15%) were asked about SMBG practice and it was found that only one third (n = 50, 35.71%) of them use glucometer to monitor their BG at home. An approximately equal percentage of male and female patients (34.32% and 36.98% respectively) acknowledged that they practice SMBG. A similar study on SMBG by Karter, et al.,  reported that 60% of type 1 and 67% of those with type 2 diabetes practiced SMBG in California, however only 7-21% of diabetic patients in Malaysia monitor their blood glucose.  A significant difference was observed (Chi test P = 0.018) when age of the respondents who practice and do not practice SMBG was compared. Out of 50 patients who monitor their BG level at home, 25 apiece (50%) were aged below and above 50 years respectively [Table 1].
|Table 1: Characteristics of respondents who self monitor and do not self monitor BG (n=140)|
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Attitude and practices of 50 patients who monitor their BG were further evaluated by self administered questionnaire and the results are presented in [Table 2]. Out of 50 participants, 27 (54%) were suffering from type 1 diabetes and 23 (46%) had type 2 diabetes. A majority of the females were having type 1diabetes in contrast to their counterparts who had type 2 diabetes. Home monitors are less accurate than laboratory monitors and many do not meet the standards of American Diabetes Association.  Although most of the Physicians believe that these devices are accurate enough to indicate low blood sugar and thus recommend and encourage use of glucometers especially for patients on insulin. A total of 26 Patients (52%) were measuring their BG based on their physician's recommendation while 48% were monitoring it as a simple desire. This reflects their positive attitude towards attaining diabetes treatment goals and to reduce the risk of diabetes related complications.
Pain or discomfort in pricking the finger is the main reason that discourages patients from monitoring their BG, however 60% of the study population was not afraid of the needle pricks. Male participants in general were more comfortable in pricking the finger than the females. But most of the participants were of the opinion that they would prefer a meter that allows testing in alternative sites.
A total of 42 respondents admitted having been explained the significance and instruction on the proper testing technique of the device by the pharmacists. Proper education is very important for SMBG, especially since there are varieties of glucometers available in market. Pharmacists can play an integral role in educating patients about the proper technique of glucometers, interpretation of data and appropriate times to test glycemic response.
A two third of the study population were satisfied with the performance of their device as it was easy to use and gave accurate results in few seconds. SMBG plays an important role in clinical intervention, therefore it is imperative that glucometer must be easy to maneuver and its values are accurate and precise. The monitoring results also helped the patients to feel and recognize the sign and symptoms when BG level was high, low or normal. It is therefore not surprising that majority of the participants (92%) would like to recommend the practice of SMBG to other diabetic patients to understand and manage their disease better.
There was not much difference found between the practices of measuring fasting or postprandial BG levels among participants. Twenty eight (56%) patients reported to measure fasting BG while 44% preferred to measure after meal. Though fasting reading gives a baseline of BG level and helps the patient in choosing the meal, but postprandial measurement aids in assessing a patients response to oral hypoglycemic agents taken just before meals or to the dose and timing of rapid-acting insulin given before meals. It is therefore, advisable to monitor BG before and after the meal to understand the relationship between food and BG.
The result of this pilot study suggests that frequency of BG monitoring was poor among the participants. The highest frequency of monitoring was once daily in 12 patients, 16 patients monitored their BG once in a week while a 44% participants were found to be irregular in monitoring their BG level that may be partly due to the cost of test strips. Karter et al.,  found that monitoring at the recommended frequency (at least daily) was associated with a better HbA 1c level of 0.4% (P = 0.0001) compared with less frequent monitoring. A previous study by Goldstein, et al.,  reported few potential barriers to practice of SMBG that include the high cost of strips, inadequate education about the practice and its benefits, and patient discomfort and inconvenience etc.
Providing physician with BG reading is an important sign to assess patient's awareness towards health care of his/her disease. 62% of the participants were providing the BG readings to adjust medication regimen while 19 patients admitted that their health care provider did not ask for the readings. International Diabetes Federation (IDF) recommends that frequency of SMBG in type 2 diabetes on oral hypoglycemic agents should be individualized but patients on insulin are advocated to carry out SMBG four times a day. 
Limitations of the study
It was conducted only among the outpatients, moreover, the study enrolled only 50 patients (small sample) from one region only and hence findings of the study can not be generalized to the diabetic population of Muscat, Oman. Larger sample is needed to generalize the findings in future studies.
| Conclusion|| |
SMBG plays an important role in clinical intervention and in the monitoring process of diabetic patients. It helps health care professionals in medication adjustments and allows diabetic patients to achieve and maintain desired glucose levels. The results of this pilot study indicated that there is a need to aware and educate the Omani diabetic patients about the importance of SMBG as only one third of study population was found to monitor their BG at home. However, participants had a positive attitude towards SMBG because most of them would like to recommend it to other diabetic patients. Overall frequency of BG monitoring was poor among the participants and had a room for the improvement. It is concluded that patient's education is the best way to achieve the desired therapeutic goals in which pharmacists must play a major role.
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[Table 1], [Table 2]