Barriers to Self Monitoring of Blood Glucose in Southwestern Hispanic and non-Hispanic White Insulin-Treated Type 2 Diabetics

Wendel CS, Mohler MJ, Brown B, Plummer E, Shah JH, Duckworth WC, Lebowitz MD, Adam K, Collier K, Murata GH. Barriers to Self Monitoring of Blood Glucose in Southwestern Hispanic and non-Hispanic White Insulin-Treated Type 2 Diabetics. Paper presented at: American Diabetes Association Annual Scientific Session; 2008 Jun 6; San Francisco, CA.

Related HSR&D Project(s)

• IIR 04-176 – Insulin Treatment Variation in Southwestern Diabetics - Therapeutic Decision-making

Hispanic Americans with diabetes have a higher burden of illness and complications than non-Hispanic whites (NHWs) and can encounter socio-cultural barriers to treatment. We conducted a multicenter, observational study of Southwestern Veterans Administration patients with insulin-treated type 2 diabetes. Self-report measures of psychological, social and cultural barriers to care, self-care behaviors, and vascular disease risk factors were collected using a mail survey. Clinical measures were derived from the automated medical record system. Findings are age-adjusted. We enrolled 233 Hispanics and 932 NHWs. Hispanics were younger (65.1 9.8 vs 68.2 10.1, p < .001), had fewer years of insulin use (9.9 9.2 vs 12.1 10.9, p = .02), but had no significant difference in years since diagnosis (18.3 10.8 vs 19.1 11.0 p = .38). There was no significant difference in A1c (7.8 1.5 vs 7.7 1.3 p = .11) or self-reported self-monitoring of blood glucose (SMBG) per day (2.6 1.2 vs 2.6 1.5). However, Hispanics reported certain barriers to SMBG more frequently. Hispanics were more likely to cite as reasons for not checking blood sugar: "Results won't make a difference" (Futility, OR = 1.8 95%CI 1.3-2.5), "Afraid of results" (Fear, OR = 1.6 95%CI 1.1-2.4), and "Don't know what to do with the numbers" (Confusion, OR = 1.8 95%CI 1.1-3.1). Moreover, these barriers significantly predicted A1c and/or daily SMBG. Futility was associated with a 0.26 decline in daily SMBG (p = .03) and a 0.21% increase in A1c (p < .001). Fear was associated with a 0.43% increase in A1c (p < .001) but not with SMBG rate. Confusion was associated with a 0.47 decline in daily SMBG (p = .02) and a 0.31% increase in A1c (p = .05). Among further differences in barriers to care to be presented, Hispanics were more likely to report needle aversion (OR = 1.8 95%CI 1.2-2.8) and shame about diabetes (OR = 2.2 95%CI 1.3-3.7). Needle aversion was associated with a 0.48% increase in A1c (p < .001). Although A1c and SMBG rate did not vary by ethnicity in our sample, we have identified psychological traits that may help explain why Hispanics have poorer control in most populations. Feelings of futility about monitoring, fear of the results, and confusion about future actions have detrimental effects on the rate of monitoring and glycemic control, suggesting that additional counseling should be provided to this population.