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Frequent Self-Monitoring Blood Glucose Correlated to Better Medication Adherence and Glycemic Control in Children
Nur Rochmah1,2, Soetjipto Soetjipto3, Muhammad Faizi1,2
1Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Insights
Higher frequency of self-monitoring of blood glucose (SMBG) in children with type 1 diabetes is linked to better glycemic control and medication adherence. However, less than 50% of Indonesian children meet recommended SMBG guidelines.
Area of Science:
- Pediatric Endocrinology
- Diabetes Management
- Public Health
Background:
- Type 1 diabetes mellitus (T1DM) is a prevalent chronic childhood condition with significant complications.
- Effective diabetes management hinges on glycemic control, primarily influenced by self-monitoring of blood glucose (SMBG) compliance.
- In Indonesia, traditional finger-stick devices are common, yet only about 20% of children adhere to recommended SMBG frequencies (4-6 times daily).
Purpose of the Study:
- To investigate the relationship between SMBG adherence and glycemic control in Indonesian children with T1DM.
- To assess psychosocial conditions and medication adherence in pediatric T1DM patients.
- To provide insights into improving diabetes management strategies within the Indonesian context.
Main Methods:
- A single-center, cross-sectional study involving 36 children (aged 4-18) with T1DM at Dr. Soetomo Hospital, Surabaya, Indonesia (July-November 2022).
- SMBG compliance was assessed via questionnaire.
- Psychosocial factors and medication adherence were evaluated using the Pediatric Symptom Checklist 17 and ARMS-D, respectively. Statistical analyses included Pearson correlation and linear regression.
Main Results:
- SMBG frequency exceeding 4 times daily significantly correlated with increased medication adherence (p=0.012).
- Higher SMBG frequency was associated with lower HbA1c levels (p=0.014, r=0.406) and improved nutritional status (p=0.031, r=0.360).
- Less than 50% of Indonesian pediatric T1DM patients met the recommended SMBG guideline of at least 4 times per day.
Conclusions:
- Increased SMBG frequency is linked to better glycemic control and adherence in children with T1DM.
- There is a critical need for enhanced support to promote adherence to national SMBG guidelines among pediatric patients in Indonesia.
- Future research should consider larger sample sizes and multi-center collaborations to validate these findings.
Background:
Type 1 diabetes mellitus (T1DM) is the most common chronic disease in children, with several severe short and long-term complications. Glycemic control is an important aspect of diabetes management with the most influential factor being compliance with self-monitoring blood glucose (SMBG). Mostly, in Indonesia, the finger stick devices as a glucose monitoring tool were frequently used. About 20% of children follow the recommendation to measure blood glucose four to six times daily.
Methods:
This is a single center, cross-sectional study that was conducted between July-November 2022. The Population is children with T1DM at the Pediatric Outpatient Clinic of Dr. Soetomo Hospital, Surabaya, Indonesia. Children with T1DM aged 4-18 years were enrolled using consecutive sampling. A compliance questionnaire was used to assess SMBG. Psychosocial conditions were assessed using the Pediatric Symptom Checklist 17, and medication adherence was evaluated using the Adherence to Refills and Medications Scale for Diabetes (ARMS-D). Pearson correlation and linear regression were employed for statistical analyses using Statistical Package for Social Sciences version 21.0, with p < 0.05 indicating statistical significance.
Results:
A total of 36 children were included in this study. SMBG frequency over 4x per day was significantly associated with increased medication adherence as measured by the ARMS-D score (p = 0.012). Higher SMBG frequency was also correlated with decreased HbA1c (p = 0.014, r = 0.406) and nutritional status (p = 0.031, r = 0.360). Less than 50% of the patients in Indonesia adhered to the recommended guidelines for SMBG (ie, ≥4 times per day).
Conclusion:
Higher SMBG frequency was correlated with better glycemic control. This finding suggests the need for further support in conducting SMBG based on the national guideline. However, due to it being conducted in a single center, we suggest increasing the sample size or conducting multi-centre collaborations in future studies.
Originality/Value:
By specifically investigating the relationship between adherence to self-monitoring of blood glucose (SMBG) and glycemic control in children with type 1 diabetes mellitus (T1DM), our study represents a novel contribution to the field of pediatric diabetes management in Indonesia. While previous research has explored similar relationships in other populations, our study focuses exclusively on the unique context of Indonesia, where rates of adherence to SMBG in pediatric patients have not been well studied and are relatively low compared to global standards.
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