The Burden of Structured Self-Monitoring of Blood Glucose on Diabetes-Specific Quality of Life and Locus of Control in Patients with Noninsulin-Treated Type 2 Diabetes: The PRISMA Study

Abstract

Background: To evaluate whether structured self-monitoring of blood glucose (SMBG) is associated with changes in diabetes-specific quality of life (DSQoL) and locus of control (LOC) in patients with noninsulin-treated type 2 diabetes (T2DM).Study Design and Methods: In this analysis of the PRISMA (Prospective Randomized Trial on Intensive SMBG Management Added Value in Noninsulin-Treated T2DM Patients) Study psychosocial data, we evaluated the impact of 12 months of structured SMBG on the individual domains of DSQoL and LOC questionnaires, including the role of selected confounders.Results: The score for Satisfaction, Impact, and Worry domains (DSQoL) improved when compared with baseline, without significant differences between structured SMBG regimen (intervention group, n = 501) and active control group (n = 523). Scores for Internal, Chance, and Powerful Others domains (LOC) improved compared with baseline, with a significant between-group change in Chance (P = 0.0309). For DSQoL domain score, improvements were associated with higher number of SMBG measurements (P = 0.007), older age (P = 0.013), and male sex (P = 0.0133) for Satisfaction and with male sex (P < 0.0001) for Worry. Concerning LOC domain score, improvements were associated with longer diabetes duration (P = 0.0084) and younger age (P < 0.0001) for Chance and total number of SMBG measurements (P = 0.0036) for Internal, with the intervention group close to being significant (P = 0.06).Conclusions: Our analysis demonstrates that in patients with noninsulin-treated T2DM, structured SMBG is not associated with a deterioration of quality of life and LOC, which is strongly predicted by demographics and diabetes-related variables. These findings should be considered when tailoring educational support to SMBG for these patients.

Patient Perspectives on Self-Monitoring of Blood Glucose When not Using Insulin: a Cross-sectional Survey

“…Several randomized trials have found no difference in quality of life between patients randomized to SMBG and controls. 7,8,17 In contrast, 61% of respondents in our study believed it did, and even respondents who wanted to stop SMBG often felt that way. It is possible that in the randomized trials, some patients had improved quality of life while others had a decrease, so that overall there was no change.…”

Patient Perspectives on Self-Monitoring of Blood Glucose When not Using Insulin: a Cross-sectional Survey

“…Several randomized trials have found no difference in quality of life between patients randomized to SMBG and controls. 7,8,17 In contrast, 61% of respondents in our study believed it did, and even respondents who wanted to stop SMBG often felt that way. It is possible that in the randomized trials, some patients had improved quality of life while others had a decrease, so that overall there was no change.…”

Effects of structured testing versus routine testing of blood glucose in diabetes self-management: A randomized controlled trial

“…Inexplicable readings can be distressing, resulting in a sense of personal "failure" with unexpected values of glucose levels (Peel et al, 2004). However, structured SMBG was not associated with deterioration of quality of life and locus of control (Russo et al, 2016). Our study also showed that mood status was not affected by lower frequency SMBG tests, in that no participants dropped out of the study and they all followed the study protocol nearly perfectly.…”

Diabetes-Related Quality of Life: Learning From Individuals Making Lifestyle Changes to Improve Type 2 Diabetes Control

“…9-11 Similar patterns have been found in the association of blood glucose self-monitoring increasing psychological stress, which in turn affects QoL. 12 Furthermore, QoL is infrequently accounted for when planning and selecting interventions for individuals within neighborhoods that are disproportionately impacted by diabetes and systematic inequities. Ideally, interventions designed to improve overall health would also improve or sustain the individual’s QoL, prioritizing patient-centered care.…”

Patient Perspectives on Self-Monitoring of Blood Glucose When not Using Insulin: a Cross-sectional Survey

“…Several randomized trials have found no difference in quality of life between patients randomized to SMBG and controls. 7,8,17 In contrast, 61% of respondents in our study believed it did, and even respondents who wanted to stop SMBG often felt that way. It is possible that in the randomized trials, some patients had improved quality of life while others had a decrease, so that overall there was no change.…”

Effects of structured testing versus routine testing of blood glucose in diabetes self-management: A randomized controlled trial

“…Inexplicable readings can be distressing, resulting in a sense of personal "failure" with unexpected values of glucose levels (Peel et al, 2004). However, structured SMBG was not associated with deterioration of quality of life and locus of control (Russo et al, 2016). Our study also showed that mood status was not affected by lower frequency SMBG tests, in that no participants dropped out of the study and they all followed the study protocol nearly perfectly.…”

Diabetes-Related Quality of Life: Learning From Individuals Making Lifestyle Changes to Improve Type 2 Diabetes Control

“…9-11 Similar patterns have been found in the association of blood glucose self-monitoring increasing psychological stress, which in turn affects QoL. 12 Furthermore, QoL is infrequently accounted for when planning and selecting interventions for individuals within neighborhoods that are disproportionately impacted by diabetes and systematic inequities. Ideally, interventions designed to improve overall health would also improve or sustain the individual’s QoL, prioritizing patient-centered care.…”

Patient Perspectives on Self-Monitoring of Blood Glucose When not Using Insulin: a Cross-sectional Survey

“…Several randomized trials have found no difference in quality of life between patients randomized to SMBG and controls. 7,8,17 In contrast, 61% of respondents in our study believed it did, and even respondents who wanted to stop SMBG often felt that way. It is possible that in the randomized trials, some patients had improved quality of life while others had a decrease, so that overall there was no change.…”

Effects of structured testing versus routine testing of blood glucose in diabetes self-management: A randomized controlled trial

“…Inexplicable readings can be distressing, resulting in a sense of personal "failure" with unexpected values of glucose levels (Peel et al, 2004). However, structured SMBG was not associated with deterioration of quality of life and locus of control (Russo et al, 2016). Our study also showed that mood status was not affected by lower frequency SMBG tests, in that no participants dropped out of the study and they all followed the study protocol nearly perfectly.…”

Diabetes-Related Quality of Life: Learning From Individuals Making Lifestyle Changes to Improve Type 2 Diabetes Control

“…9-11 Similar patterns have been found in the association of blood glucose self-monitoring increasing psychological stress, which in turn affects QoL. 12 Furthermore, QoL is infrequently accounted for when planning and selecting interventions for individuals within neighborhoods that are disproportionately impacted by diabetes and systematic inequities. Ideally, interventions designed to improve overall health would also improve or sustain the individual’s QoL, prioritizing patient-centered care.…”