Cameron Dawn, Harris Fiona, Evans Josie M M
Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK.
BMJ Open Diabetes Res Care. 2018 Sep 19;6(1):e000538. doi: 10.1136/bmjdrc-2018-000538. eCollection 2018.
To explore how and why self-monitoring of blood glucose (SMBG) is carried out in a real-world context.
We conducted a multicase study among ten people with type 1 and insulin-treated type 2 diabetes mellitus in Scotland, alongside seven nominated support people and four healthcare professionals. All participants were interviewed in depth and six participants provided SMBG diaries. Stones' version of structuration theory informed the analysis.
People with diabetes were able to provide immediate motives for SMBG at particular times, often having different motives on different occasions. We identified six such motives, including routine, in response to symptoms, associated with a diabetes review, to facilitate lifestyle, when a 'good' result was expected, and higher level motives for longer term glycemic control. These motives were influenced by underlying attitudes toward diabetes that included level of engagement and responsibility for diabetes, a desire not to be controlled by diabetes, resistance to diabetes, diabetes education and relationship with the health service, fear of hypoglycemia, and prevention of diabetes complications. Five responses to test results were identified, depending on the immediate motive and underlying attitudes.
People with insulin-treated diabetes do not necessarily self-monitor with an explicit goal of improving long-term glycemic control, but may have other motives that are important to them. An individualized understanding is therefore needed to advise people with diabetes how SMBG can be optimized for them.
探讨在现实环境中血糖自我监测（SMBG）是如何以及为何进行的。
我们在苏格兰对10名1型糖尿病患者和接受胰岛素治疗的2型糖尿病患者、7名指定的支持人员以及4名医疗保健专业人员进行了多案例研究。所有参与者都接受了深入访谈，6名参与者提供了血糖自我监测日记。分析以斯通版本的结构化理论为依据。
糖尿病患者能够说出在特定时间进行血糖自我监测的直接动机，而且在不同场合往往有不同的动机。我们确定了六种这样的动机，包括日常监测、对症状的反应、与糖尿病复查相关、为便利生活方式、期望获得“良好”结果以及更高层次的长期血糖控制动机。这些动机受到对糖尿病的潜在态度的影响，这些态度包括对糖尿病的参与程度和责任感、不想被糖尿病控制的愿望、对糖尿病的抵触情绪、糖尿病教育以及与医疗服务的关系、对低血糖的恐惧以及预防糖尿病并发症。根据直接动机和潜在态度，确定了对检测结果的五种反应。
接受胰岛素治疗的糖尿病患者不一定以改善长期血糖控制为明确目标进行自我监测，而是可能有对他们来说很重要的其他动机。因此，需要进行个性化的了解，以便为糖尿病患者提供关于如何优化血糖自我监测的建议。
