title: Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes.
abstract: OBJECTIVE
  Self-monitoring of blood glucose (SMBG) is a cornerstone of diabetes care, but little is known about barriers to this self-care practice.
  
  
  METHODS
  This cross-sectional study examines SMBG practice patterns and barriers in 44,181 adults with pharmacologically treated diabetes from the Kaiser Permanente Northern California Region who responded to a health survey (83% response rate). The primary outcome is self-reported frequency of SMBG.
  
  
  RESULTS
  Although most patients reported some level of SMBG monitoring, 60% of those with type 1 diabetes and 67% of those with type 2 diabetes reported practicing SMBG less frequently than recommended by the American Diabetes Association (three to four times daily for type 1 diabetes, and once daily for type 2 diabetes treated pharmacologically). Significant independent predictors of nonadherent practice of SMBG included longer time since diagnosis, less intensive therapy, male sex, age, belonging to an ethnic minority, having a lower education and neighborhood income, difficulty communicating in English, higher out-of-pocket costs for glucometer strips (especially for subjects with lower incomes), smoking, and excessive alcohol consumption.
  
  
  CONCLUSIONS
  Considerable gaps persist between actual and recommended SMBG practices in this large managed care organization. A somewhat reduced SMBG frequency in subjects with linguistic barriers, some ethnic minorities, and subjects with lower education levels suggests the potential for targeted, culturally sensitive, multilingual health education. The somewhat lower frequency of SMBG among subjects paying higher out-of-pocket expenditures for strips suggests that removal of financial barriers by providing more comprehensive coverage for these costs may enhance adherence to recommendations for SMBG.
authors.affiliation: Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94611-5714, USA. ajk@dor.kaiser.org
authors.forename: A J
authors.initials: AJ
authors.lastname: Karter
authors.forename: A
authors.initials: A
authors.lastname: Ferrara
authors.forename: J A
authors.initials: JA
authors.lastname: Darbinian
authors.forename: L M
authors.initials: LM
authors.lastname: Ackerson
authors.forename: J V
authors.initials: JV
authors.lastname: Selby
mesh_terms: D000328:Adult; D015190:Blood Glucose Self-Monitoring; D002140:California; D003142:Communication; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000523:psychology; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006279:Health Maintenance Organizations; D006306:Health Surveys; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D010349:Patient Compliance; D044469:Racial Groups; D012042:Registries; D015203:Reproducibility of Results