A study led by Dr Josie Evans, Senior Lecturer in Public Health in the School of Nursing Midwifery and Health at the University of Stirling, has found that self-monitoring blood glucose levels at home by patients with type 2 diabetes not using insulin, did not always lead to better blood glucose control.
Research involved interviewing 207 patients with type 2 diabetes to find out how they self-monitored their blood glucose levels at home. Over 60 per cent of people took no action in response to test readings, the majority of them stating the reason for this being that they did not know what action to take.
In addition, many people perceived a high reading to be 10mmol/l or above, higher than many health care professionals would advise.
Dr Evans said: “This lack of knowledge was one of our main findings and I was surprised to learn the extent of misunderstandings over high readings. Most people said a high reading was 10 or above when ideally, patients’ blood glucose levels should be less than 7.
“The fact that patients don’t know how to interpret the readings and react to them was a very important finding.
“More than half of the patients were taking no action in response to self-monitoring. Some patients find it very frustrating if they have a high reading as they are unsure what to do about it. They know what to do if they have a low blood glucose reading but the opposite is confusing.
“There is clearly a lack of knowledge, with patients needing more education surrounding monitoring if they are to monitor effectively. There is no point in patients self-monitoring unless they are educated in how to interpret readings and to respond appropriately and this may be why patients who self-monitored did not seem to have better blood glucose control.
“If the NHS is spending all this money on self-monitoring there has to be better education surrounding it. There has to be the right knowledge and training for self-monitoring to be effective.”
There are around 2.6 million people in the UK with diabetes – around four per cent of the population. The majority of these have type 2 diabetes. The two year study, funded by the Chief Scientist Office, was carried out in Tayside. Dr Evans will present the findings to the Scottish School of Primary Care Conference in Edinburgh in April.
The University of Stirling is working closely with lay service users on research and type 2 diabetic Bob Cromb, from Dunning, near Perth, was asked to sit on the interview panel for the researcher role for the study and give feedback on the findings.
Bob was diagnosed with diabetes in 1992, although the 74-year-old was told he had a low tolerance to sugar in 1986. He says he can “understand the frustrations even with diabetic knowledge of taking an effective action to improve readings.”
He added: “The main thing about discovering you are diabetic is the hopelessness of it – it can be a real horror to discover. I think the disease carries a stigma due to the needles - there is a fear that surrounds it.
“Some people bury their head in the sand when they are diagnosed with diabetes. There needs to be better education about the condition.”
Bob, an ironmonger and former local councillor, found attempts to help his condition by controlling his diet unsuccessful and in 2007 he began self-medicating with insulin. “My life was very difficult for a long time before I started taking insulin,” he said. “I felt much better after I started on it, but I wasn’t sure I was self-monitoring properly. I was just doing the best I could and struggled on.”
Bob was motivated to educate himself about his condition and realises now that “when my blood sugar drops to three I get what looks like a blue map of Australia interrupting my vision –that’s my warning to take action.” Bob also now walks around three to four miles a day which helps his condition and Bob finds this exercise is the equivalent to one insulin injection.
He added: “Someone told me they regularly have a self-monitoring reading of 17 but they seem to think that is okay. One problem the National Health Service faces is that you can give people the knowledge but whether they choose to ignore or act on it is another story. But I know that having found out a lot more information and managing my condition life is so much better for me now.”