Page 25 - Glucose Monitoring Devices

20 CHAPTER 1 Introduction to SMBG

per day or more [111]. Similarly, the analysis of SMBG data from over 13,000
people with T2D found that SMBG is underutilized both in insulin-treated and
noninsulin-treated individuals. In addition, postprandial glucose values were seldom
checked suggesting nonadherence to the structured SMBG schemes [112].
There are several factors that may influence SMBG adherence. In a study by
Vincze et al., environmental barriers, such as lifestyle interference, inconvenience,
painfulness, and cost, were significantly associated with adherence to SMBG
[113]. On the other hand, in a study by Fisher et al., SMBG information, motivation,
and behavioral skills deficits were significantly correlated with SMBG frequency
among individuals both with T1D and T2D, and accounted for 25% of the variability
in SMBG frequency among individuals with T1D and for 9% of the variance in
SMBG frequency among individuals with T2D. Moreover, a substantial proportion
of individuals was unconvinced of SMBG usefulness [114]. Similarly, in a Swedish
survey, 30% of adults with T1D were not aware that four or more SMBG measure-
ments were recommended, implying a need for appropriate education addressing
current guidelines [111]. Self-management interventions, such as education,
problem-solving, contingency management, goal setting, cognitive-behavioral ther-
apy, and motivational interviewing, demonstrated at least short-term improvements
in adherence to recommended SMBG frequency [115]. Although the pain associated
with finger pricking has been reduced with modern lancing devices [112], approxi-
mately 34% of individuals with T1D and 35% with T2D viewed SMBG as painful
[116]. On the contrary, in a self-reported Swedish survey, only 14% of adults with
T1D stated SMBG-associated pain as the main reason for not performing SMBG
according to recommendations [111]. The questionnaire-based survey from 517
individuals with T1D and 1648 with T2D showed that individuals experiencing
SMBG-associated pain had more mental distress, lower health-related quality of
life, higher HbA1c, and appreciated the importance of SMBG less [117].
SMBG may potentially have adverse psychological effects in some individuals
[76,118,119]. In noninsulin-treated T2D, SMBG frequency of one or more times
per day was associated with higher levels of distress, worries, and depressive symp-
toms [118]. A systematic review of SMBG in T2D revealed a lack of education on
how to interpret SMBG results together with the omission of appropriate lifestyle
and treatment adjustments [119]. Hence, structured SMBG with sufficient education
on how to interpret and respond to SMBG results was not associated with a deteri-
oration of quality of life in noninsulin-treated individuals with T2D [84].
Underutilization of glucose data from both SMBG and continuous glucose
monitoring (CGM), lack of easy and standardized glucose data collection, analysis,
visualization, and guided clinical decision-making were found to be key contributors
to poor glycemic control among individuals with T1D [120]. Recent data from T1D
Exchange showed that 71% of non-CGM users and 60% of CGM users never down-
loaded the blood glucose meter outside of the doctor’s office despite the increased
use of the devices. Similarly, the use of a mobile medical application was as low