Self Monitoring of Blood Glucose Among Patients with Type 2 Diabetes Mellitus in Eastern Nigeria: Need for Multi-strategic Interventions

Abstract

Despite high awareness, SMBG practice is grossly inadequate and is associated with a huge economic burden that may be unsustainable in a resource-poor country like Nigeria. Measures aimed at reducing the cost of glucometers and strips, and improving diabetes education are recommended.

Facilitators and barriers to self-monitoring of blood glucose (SMBG) in diabetic patients visiting family medicine clinics at Akuh. 

“…In United States of America test strips are reimbursed for the diabetics, even then the patients reported that SMBG was costly. A study conducted in 2007 by Khowaja et al reported that the annual mean direct cost for each person with diabetes was estimated to be Pakistani rupees 11,580 (US$ 197) (36). Medicines accounted for the direct cost (46%), followed by laboratory investigations (32%) (36).…”

“…A study conducted in 2007 by Khowaja et al reported that the annual mean direct cost for each person with diabetes was estimated to be Pakistani rupees 11,580 (US$ 197) (36). Medicines accounted for the direct cost (46%), followed by laboratory investigations (32%) (36). In the study large number of participants had an average house hold income between PKR 20,000 to 50,000; this may be a reason of why only 30% of the patients were practicing SMBG.…”

Glycemic impact of intensified self monitoring of blood glucose in insulin treated subjects with type 2 diabetes mellitus

“…The cost of intensified SMBG is prohibitive. [12,13] Therefore, the quest to justify its use in stable insulin-treated subjects with T2DM, who are not on multidose insulin regimen, is justifiable.…”

“…This frequency may be difficult to adapt in real life, especially in resource-poor countries such as sub-Saharan Africa. Ugwu et al [13] recently reported that only 7.9% of subjects with T2DM in Eastern Nigeria performed SMBG at least once daily. Even in developed countries with higher income, it has been shown that the real-life mean blood glucose testing frequency in insulin-treated T2DM patients ranges from 1.7 tests/day in Spain to 3 tests/day in Canada.…”

“…[26] Studies have consistently highlighted the huge costs associated with SMBG. [12,13,17,18] In 2011, the National Health Service in the United Kingdom reportedly spent £158 million on SMBG, representing about 21% of the diabetes treatment costs. [12] It is estimated that an equivalent of about $126 million is spent on SMBG annually in Nigeria.…”