Objective To explore how and why self-monitoring of blood glucose (SMBG) is carried out in a real-world context.
Research design and methods We conducted a multicase study among ten people with type 1 and insulin-treated type 2 diabetes mellitus in Scotland, alongside seven nominated support people and four healthcare professionals. All participants were interviewed in depth and six participants provided SMBG diaries. Stones’ version of structuration theory informed the analysis.
Results People with diabetes were able to provide immediate motives for SMBG at particular times, often having different motives on different occasions. We identified six such motives, including routine, in response to symptoms, associated with a diabetes review, to facilitate lifestyle, when a ‘good’ result was expected, and higher level motives for longer term glycemic control. These motives were influenced by underlying attitudes toward diabetes that included level of engagement and responsibility for diabetes, a desire not to be controlled by diabetes, resistance to diabetes, diabetes education and relationship with the health service, fear of hypoglycemia, and prevention of diabetes complications. Five responses to test results were identified, depending on the immediate motive and underlying attitudes.
Conclusions People with insulin-treated diabetes do not necessarily self-monitor with an explicit goal of improving long-term glycemic control, but may have other motives that are important to them. An individualized understanding is therefore needed to advise people with diabetes how SMBG can be optimized for them.
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Contributors DC, FH and JMME designed the project. DC conducted all recruitment and fieldwork, and carried out qualitative analysis. FH supervised the qualitative analysis, and JMME contributed to analysis. DC wrote the first draft of the paper. JMME edited the first draft and was responsible for the final draft. All three authors approved the final version. JMME is the guarantor.
Funding This study was undertaken within a PhD studentship that was part-funded by Lifescan, Inverness. The researchers were independent of the funding body.
Competing interests None declared.
Patient consent Not required.
Ethics approval Ethical approval for this study was obtained from the Research Ethics Committee of the School of Health Sciences, University of Stirling, and from the East of Scotland NHS Research Ethics Service (13/ES/0119).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement There are no additional data available from this study.
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