Harris M I, Cowie C C, Howie L J
National Diabetes Data Group, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892.
Diabetes Care. 1993 Aug;16(8):1116-23. doi: 10.2337/diacare.16.8.1116.
To evaluate self-monitoring of blood glucose, which is considered an important practice for patients with diabetes. However, little is known about the frequency or determinants of this technique.
A detailed questionnaire on diabetes was administered to a representative sample of 2405 diabetic subjects > or = 18 yr of age in the U.S. population in the 1989 National Health Interview Survey.
Among subjects with IDDM, 40% monitored their blood glucose at least 1 time/day. Among subjects with NIDDM treated with insulin, 26% monitored at least 1 time/day and among NIDDM subjects not treated with insulin, the percentage was 5%. When stratified by age, little difference was observed between IDDM subjects and insulin-treated NIDDM subjects in the percentage testing at least 1 time/day. By multivariate analysis, age and insulin use were the major determinants of whether diabetic subjects tested their blood glucose. Race and education were also independently related to self-monitoring of blood glucose. Blacks were 60% less likely to test their blood glucose at least 1 time/day compared with non-Hispanic whites and Mexican Americans. Those with college education were 80% more likely to test their blood glucose compared with those with lower education levels. Having had a patient education class in diabetes management and frequent physician visits for diabetes care were positively related to self-testing. Self-monitoring was not related to higher income or having health insurance.
A large proportion of patients with diabetes do not test their blood glucose. Financial barriers associated with income and health insurance do not appear to impede the practice of self-monitoring. Because of the importance of blood glucose control in the prevention of diabetes complications and the role of self-monitoring in achieving blood glucose control, it may be prudent for physicians and their patients to make greater use of this technique. Special attention should be directed to the subgroups of patients (blacks, patients not treated with insulin, those with less education, and those with no education in diabetes) in which the frequency of self-monitoring is particularly low.
评估血糖自我监测情况，血糖自我监测被视为糖尿病患者的一项重要措施。然而，对于该技术的监测频率或决定因素却知之甚少。
在1989年全国健康访谈调查中，针对美国2405名年龄≥18岁的糖尿病患者代表性样本，发放了一份关于糖尿病的详细问卷。
在胰岛素依赖型糖尿病（IDDM）患者中，40%的患者每天至少监测1次血糖。在接受胰岛素治疗的非胰岛素依赖型糖尿病（NIDDM）患者中，26%的患者每天至少监测1次血糖；而在未接受胰岛素治疗的NIDDM患者中，这一比例为5%。按年龄分层后，IDDM患者和接受胰岛素治疗的NIDDM患者中，每天至少检测1次血糖的比例差异不大。多因素分析显示，年龄和胰岛素使用情况是糖尿病患者是否进行血糖检测的主要决定因素。种族和教育程度也与血糖自我监测独立相关。与非西班牙裔白人及墨西哥裔美国人相比，黑人每天至少检测1次血糖的可能性低60%。与教育程度较低者相比，受过大学教育的人检测血糖的可能性高80%。参加过糖尿病管理患者教育课程以及因糖尿病护理频繁就医与自我检测呈正相关。自我监测与高收入或拥有医疗保险无关。
很大一部分糖尿病患者不进行血糖检测。与收入和医疗保险相关的经济障碍似乎并未阻碍自我监测行为。鉴于血糖控制在预防糖尿病并发症中的重要性以及自我监测在实现血糖控制中的作用，医生及其患者更广泛地使用该技术可能是明智之举。应特别关注自我监测频率特别低的患者亚组（黑人、未接受胰岛素治疗的患者、教育程度较低的患者以及未接受糖尿病教育的患者）。
