Improving diabetic control in adverse social conditions. A home blood glucose monitoring study in Soweto, South Africa.

In order to explore the feasibility of home blood glucose monitoring (HBGM) in Type 1 diabetics in developing countries, we introduced the technique to Type 1 patients below the age of 30 yr attending the Diabetic Clinic serving Soweto in South Africa. Despite initial problems, HBGM with visually-read strips was applied to 45 of the 64 young Type 1 diabetics identified ("HBGM group"). The remaining 19 were continued on urine glucose monitoring only ("HUGM group"), usually because of attendance and compliance problems. After 4 months' follow-up, glycosylated haemoglobin (HbA1) fell from 10.5 +/- 2.6% (mean +/- SD) to 9.0 +/- 1.7 (p less than 0.001) in the HBGM group, but was unchanged (10.1 +/- 2.1 vs 9.9 +/- 1.9, pn.s.) in HUGM patients. HBGM can thus be introduced in adverse social conditions, and may be associated with improved diabetic control. Costs, in terms of finance and medical time, were not excessive. Unfortunately, a significant minority were excluded by attendance and other problems, and analysis of diabetic complication rates (before the programme began) showed that these patients had significantly more complications than those deemed suitable for HBGM (42.1% vs 15.5%, p less than 0.05).