Faculty of Medicine Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Department of Endocrinology Muhimbili National Hospital, Dar es Salaam, Tanzania.
J Diabetes Res. 2024 Jun 10;2024:6789672. doi: 10.1155/2024/6789672. eCollection 2024.
Tracking of blood glucose levels by patients and care providers remains an integral component in the management of diabetes mellitus (DM). Evidence, primarily from high-income countries, has illustrated the effectiveness of self-monitoring of blood glucose (SMBG) in controlling DM. However, there is limited data on the feasibility and impact of SMBG among patients in the rural regions of sub-Saharan Africa. This study is aimed at assessing SMBG, its adherence, and associated factors on the effect of glycaemic control among insulin-treated patients with DM in northeastern Tanzania. This was a single-blinded, randomised clinical trial conducted from December 2022 to May 2023. The study included patients with DM who had already been on insulin treatment for at least 3 months. A total of 85 participants were recruited into the study and categorised into the intervention and control groups by a simple randomization method using numbered envelopes. The intervention group received glucose metres, test strips, logbooks, and extensive SMBG training. The control group received the usual care at the outpatient clinic. Each participant was followed for a period of 12 weeks, with glycated haemoglobin (HbA) and fasting blood glucose (FBG) being checked both at the beginning and at the end of the study follow-up. The primary and secondary outcomes were adherence to the SMBG schedule, barriers associated with the use of SMBG, and the ability to self-manage DM, logbook data recording, and change in HbA. The analysis included descriptive statistics, paired -tests, and logistic regression. Eighty participants were analysed: 39 in the intervention group and 41 in the control group. In the intervention group, 24 (61.5%) of patients displayed favourable adherence to SMBG, as evidenced by tests documented in the logbooks and glucometer readings. Education on SMBG was significantly associated with adherence. Structured SMBG improved glycaemic control with a HbA reduction of -1.01 (95% confidence interval (CI) -1.39, -0.63) in the intervention group within 3 months from baseline compared to controls of 0.18 (95% CI -0.07, 0.44) ( < 0.001). Structured SMBG positively impacted glycaemic control among insulin-treated patients with DM in the outpatient clinic. The results suggest that implementing a structured testing programme can lead to significant reductions in HbA and FBG levels. Pan African Clinical Trials Registry identifier: PACTR202402642155729.
患者和医护人员对血糖水平的跟踪监测仍然是糖尿病管理的一个重要组成部分。主要来自高收入国家的证据表明，自我血糖监测（SMBG）在控制糖尿病方面是有效的。然而，在撒哈拉以南非洲农村地区的患者中，关于 SMBG 的可行性和影响的数据有限。本研究旨在评估坦桑尼亚东北部接受胰岛素治疗的糖尿病患者的 SMBG 及其依从性，以及对血糖控制的影响。 这是一项于 2022 年 12 月至 2023 年 5 月进行的单盲、随机临床试验。该研究纳入了已经接受胰岛素治疗至少 3 个月的糖尿病患者。共有 85 名参与者被纳入研究，并通过使用编号信封的简单随机化方法分为干预组和对照组。干预组接受血糖仪、测试条、日志本和广泛的 SMBG 培训。对照组在门诊接受常规护理。每个参与者都接受了为期 12 周的随访，在研究随访开始和结束时都检查了糖化血红蛋白（HbA）和空腹血糖（FBG）。主要和次要结局是 SMBG 计划的依从性、与 SMBG 使用相关的障碍以及自我管理糖尿病的能力、日志数据记录和 HbA 的变化。分析包括描述性统计、配对检验和逻辑回归。 对 80 名参与者进行了分析：干预组 39 名，对照组 41 名。在干预组中，24 名（61.5%）患者的 SMBG 依从性良好，这一点可以从日志本中的记录和血糖仪读数中得到证明。SMBG 教育与依从性显著相关。与对照组相比，结构化 SMBG 在 3 个月内使 HbA 降低了 -1.01（95%置信区间（CI）-1.39，-0.63），而对照组仅降低了 0.18（95%CI-0.07，0.44）（<0.001），从而改善了血糖控制。 结构化 SMBG 对门诊接受胰岛素治疗的糖尿病患者的血糖控制产生了积极影响。结果表明，实施结构化检测方案可显著降低 HbA 和 FBG 水平。 泛非临床试验注册中心标识：PACT R202402642155729。
