Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study

Figures & data

Figure 1 Conceptual framework of factors influencing the use of SMBG.

Notes: ^aLifestyle includes diet, exercise, travel, fasting and work.
Abbreviation: SMBG, self-monitoring of blood glucose.

Table 1 Summary of interview topic guide on barriers and facilitators to SMBG

• How did you start testing your blood sugar at home? Who advised you? Why do you need to do the test?

○ Physician, pharmacist, diabetes nurse, family, friends, self

• How often do you test your blood sugar at home?

• What is your physician’s recommendation on testing frequency? Do you follow? Why?

• Are there times that you stop testing or test more often? Why?

○ Sick, travel, fasting, special occasion, work

• What do you understand about your blood sugar reading at home? What do you do with the reading?

• What difficulties or problems did you encounter? How and why?

• What kind of help do you need to overcome these barriers?

Abbreviation: SMBG, self-monitoring of blood glucose.

Table 2 Participants’ demographic and clinical background

Characteristics	Number of participants (%)
n	15
Age (years), mean ± SD (range)	58.7±14 (23–83)
Sex
Male	8 (53)
Female	7 (47)
Ethnicity
Malay	3 (20)
Chinese	6 (40)
Indian	6 (40)
Marital status
Single	2 (13.3)
Married	11 (73.4)
Widower	2 (13.3)
Highest level of education
None	1 (6.6)
Primary school	2 (13.3)
Secondary school	7 (47)
Diploma	3 (20)
Undergraduate degree	1 (6.6)
Undisclosed*	1 (6.6)
Duration of diabetes (years), mean ± SD (range)	14.1±7.6 (1–30)
Duration of SMBG, mean ± SD (range)	3.4±2.8 years (2 months–10 years)
HbA1c level, mean ± SD (range)†
%	8.4±1 (6.4–9.6)
mmol/mol	68.7±10.7 (46–81)

Notes:

* Participant refused to disclose the information

† participants’ latest value at the time of interview.

Abbreviations: HbA_1c, glycated hemoglobin; SD, standard deviation; SMBG, self-monitoring of blood glucose.

Table 3 Barriers and facilitators to SMBG by people with type 2 diabetes using insulin

Barriers	• Cost of test strips and needles
	• Frustration related to high blood glucose reading
	• Perception that SMBG was only for insulin titration
	• Stigma
	• Fear of needles and pain
	• Inconvenience
	• Unconducive workplace
	• Lack of motivation
	• Lack of knowledge and self-efficacy
Facilitators	• Experiencing hypoglycemic symptoms
	• Desire to see the effects of dietary changes
	• Desire to please the physician
	• Family motivation

Abbreviation: SMBG, self-monitoring of blood glucose.