Increasing Self-Monitoring of Blood Glucose: A Pilot Study of the Effect on Corrective Actions and the Impact of Cognitive Behavioral Factors

• Published in: Journal of the American Dietetic Association Vol. 97; no. 9; p. A25
• Main Authors: Glen, M.G., Knous, B.L.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 1997
• ISSN: 0002-8223; 1878-3570
• DOI: 10.1016/S0002-8223(97)00405-7

EARNING OUTCOME: To characterize the actions taken by non-insulin dependent diabetics upon increasing the frequency of blood glucose monitoring and any relationship between these actions and cognitive or affective factors. In an ex-post facto design, non-insulin dependent diabetics (NIDDM) who self-monitor blood glucose (SMBG) were followed in a three week interval for glycemic control (GC) and corrective actions (CA), both in number and type, following a high glucose reading. Subjects were assessed as three groups: those with SMBG ≥ 14 times/week (N=6), 6–13 times/week (N=5), and ≤ 5 times/week (N=5). All subjects were followed for an additional three weeks following random assignment of three subjects from the SMBG ≤ 5 times/week group to the ≥ 14 regimen. The monitoring activity consisted of a demographic and attitudinal survey and a self-report log of glucose levels, CA taken to promote euglycemia, and pertinent health, behavioral, or functional comments. Cognitive behavioral parameters postulated to impact the initiation of behavior change were assessed using Stage of Change, Locus of Control and Health Beliefs scales. Gender distribution, educational level and income were similar among the three baseline groups. Mean age difference among the groups was significant (F=4.17, df=15, p=0.04) with the group monitoring most frequently being the youngest (59.2 years). This group had the heaviest body mass index (40.8), although group differences were not significant. Increasing the frequency of SMBG from ≤ 5 to ≥ 14 times/week was not clearly associated with a pattern of increasing CA, type of CA, or GC for both mean and fasting glucose levels. Sample size and uncontrolled baseline diabetes education were confounders of any SMBG effect. The expected associations between Health Beliefs and Locus of Control with GC or CA were not apparent. However Stage of Change was found to be positively associated with both SMBG frequency and CA taken. Subjects in the precontemplation, contemplation, and preparation (PCP) stages monitored less frequently than those in the action and maintenance (AP) level (32.4 versus 36.4 times/week) and 71 percent of the AP subjects (5 of 7) made at least one CA after a high glucose reading compared to only 44 percent of those in the PCP levels (4 of 9). This pilot study tested and supported the methodology as appropriate for the study of SMBG in NIDDM, but verified the need for larger samples to study this highly individual disorder and its complex behavioral components.