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.