title: Do diabetes mellitus patients adhere to self-monitoring of blood glucose (SMBG) and is this associated with glycemic control? Experiences from a SMBG program in western Kenya.
abstract: OBJECTIVE
  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.
authors.affiliation: Academic Model Providing Access to Healthcare, P. O. Box 4606, Eldoret, 30100, Kenya. Electronic address: ckwambui@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Wambui Charity
authors.affiliation: International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C6, Qutub Institutional Area, New Delhi 110016, India. Electronic address: AKumar@theunion.org.
authors.forename: Ajay M V
authors.initials: AMV
authors.lastname: Kumar
authors.affiliation: The Centre for International Health, University of Bergen Overlege Danielsens Hus, Årstadveien 21, Bergen, 5020, Norway. Electronic address: Sven.Hinderaker@uib.no.
authors.forename: Sven Gudmund
authors.initials: SG
authors.lastname: Hinderaker
authors.affiliation: Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Puducherry 605006, India. Electronic address: palaniccm@gmail.com.
authors.forename: Palanivel
authors.initials: P
authors.lastname: Chinnakali
authors.affiliation: Purdue University College of Pharmacy, W7555 Myers Building, 1001W. 10th Street, Indianapolis, IN, USA. Electronic address: spastaki@gmail.com.
authors.forename: Sonak D
authors.initials: SD
authors.lastname: Pastakia
authors.affiliation: Department of Internal Medicine, College of Health Sciences, School of Medicine, Moi University, P.O. Box 4606, Eldoret, 30100, Kenya. Electronic address: shoine.hoine@gmail.com.
authors.forename: Jemimah
authors.initials: J
authors.lastname: Kamano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015397:Program Evaluation; D012189:Retrospective Studies; D012424:Rural Population; D013997:Time Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Adherence; DM; Gglycemic control; Self-monitoring of blood glucose