title: Glucometer use and glycemic control among Hispanic patients with diabetes in southern Florida.
abstract: BACKGROUND
  Self-monitoring of blood glucose (SMBG) has been deemed a critical component of diabetes care in the United States. To be effective, patients must have some diabetes knowledge, glucometer proficiency, and an ability to take appropriate actions when certain readings are obtained. However, most patients take no action in response to out-of-range glucometer readings, and in many populations, SMBG practices are not associated with improved glycemic control. Thus, SMBG utilization is being reconsidered in other countries. Nonetheless, SMBG behaviors are increasingly recommended in the United States, where the Hispanic population represents the fastest-growing minority group and is disproportionately affected by suboptimal diabetes outcomes. Because a growing number of interventions aim to reduce diabetes disparities by improving glycemic control among minorities, it is essential to determine whether efforts should focus on SMBG practices. We present data on SMBG behaviors and glycemic control among participants from the Miami Healthy Heart Initiative (MHHI), a National Institutes of Health/National Heart, Lung, and Blood Institute-sponsored trial assessing a community health worker (CHW) intervention among Hispanic patients with poorly controlled diabetes.
  
  
  OBJECTIVE
  This study examined the effects of a CHW intervention on SMBG practices, glycosylated hemoglobin (HbA1c), and knowledge of appropriate responses to glucometer readings among Hispanic patients with diabetes.
  
  
  METHODS
  This study was an ancillary investigation within MHHI, a randomized, controlled trial in 300 Hispanic patients. Participants were intervention-group members who received 12 months of CHW support. Assessments were administered at baseline and poststudy to determine potential barriers to optimal health. Items from validated instruments were used to determine knowledge of appropriate responses to different glucose readings. These data were linked to HbA1c values. Means and frequencies were used to describe population characteristics and glucometer proficiency. Paired-sample t tests examined potential differences in HbA1c outcomes and SMBG practices. Qualitative data were collected from the CHWs who worked with study participants.
  
  
  RESULTS
  Our population was diverse, representing several countries. Mean HbA1c improved significantly, from 10% to 8.8% (P ≤ 0.001). SMBG practices did not change. At baseline, 96% of patients reported owning a glucometer and 94% reported knowing how to use it. However, quantitative assessments and qualitative data suggested that participants had suboptimal knowledge regarding actions that could cause an out-of-range reading or how to respond to certain readings.
  
  
  CONCLUSIONS
  SMBG behaviors were not associated with glycemic control in our sample. We conclude that a CHW intervention may improve glycemic control without improving SMBG practices. Future interventions may reconsider whether efforts should be directed toward improving SMBG behaviors.
authors.affiliation: Division of General Medicine, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: skenya@med.miami.edu.
authors.forename: Sonjia
authors.initials: S
authors.lastname: Kenya
authors.affiliation: Division of General Medicine, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Lebron
authors.affiliation: Division of General Medicine, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Reyes Arrechea
authors.affiliation: Division of Public Health and Epidemiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Hua
authors.initials: H
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation*; D003150:Community Health Workers; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000208:ethnology*; D005260:Female; D005431:Florida / Q000208:ethnology; D006442:Glycated Hemoglobin / Q000032:analysis*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: diabetes among Hispanics; diabetes disparities; glucometer use among Hispanics; glycemic control