Abstract:
Aims: Among diabetes mellitus (DM) patients with poor glycemic control enrolled into a
self-monitoring of blood glucose (SMBG) program in Kenya, to assess the level of SMBG
adherence, its associated factors and its relation to glycemic control (defined as HbA1c <7%
and/or 2% absolute reduction relative to baseline).
Methods: In this retrospective cohort study, we used routinely collected data of patients
enrolled during 2012–2013. We assessed adherence to SMBG by dividing the number of
glucose tests performed by the number recommended. A level of 80% was considered
‘good adherence’. Glycemic control was considered as absolute change from baseline of 2%.
Results: Of 164 patients (59% female; 76% rural), the proportions with good SMBG adherence
were 34%, 17%, 15% and 10% during 0–6, 7–12, 13–18 and 19–24 months into the HGM program
respectively. In multivariate analysis, male gender, urban place of residence and payment for
glucostrips were associated with poor adherence during 0–12 months. The mean reduction in
HbA1c compared to baseline was 1.2%, 1.1%, 0.8% and 0.7% at 6, 12, 18 and 24 months,
respectively. We did not find any association between SMBG adherence and glycemic control.
Conclusions: Adherence to SMBG was sub-optimal, especially among those who had to pay
for glucostrips. Patient education and provision of free glucostrips are recommended to
improve adherence and glycemic control
