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Diabetes Res Clin Pract. 2016 Feb;112:37-43. doi: 10.1016/j.diabres.2015.11.006. Epub 2015 Nov 23.

Do diabetes mellitus patients adhere to self-monitoring of blood glucose (SMBG) and is this associated with glycemic control? Experiences from a SMBG program in western Kenya.

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Academic Model Providing Access to Healthcare, P. O. Box 4606, Eldoret, 30100, Kenya. Electronic address:
International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, C6, Qutub Institutional Area, New Delhi 110016, India. Electronic address:
The Centre for International Health, University of Bergen Overlege Danielsens Hus, Årstadveien 21, Bergen, 5020, Norway. Electronic address:
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Puducherry 605006, India. Electronic address:
Purdue University College of Pharmacy, W7555 Myers Building, 1001W. 10th Street, Indianapolis, IN, USA. Electronic address:
Department of Internal Medicine, College of Health Sciences, School of Medicine, Moi University, P.O. Box 4606, Eldoret, 30100, Kenya. Electronic address:



Among diabetes mellitus (DM) patients with poor glycemic control enrolled into a self-monitoring of blood glucose (SMBG) program in Kenya, to assess the level of SMBG adherence, its associated factors and its relation to glycemic control (defined as HbA1c <7% and/or 2% absolute reduction relative to baseline).


In this retrospective cohort study, we used routinely collected data of patients enrolled during 2012-2013. We assessed adherence to SMBG by dividing the number of glucose tests performed by the number recommended. A level of ≥ 80% was considered 'good adherence'. Glycemic control was considered as absolute change from baseline of 2%.


Of 164 patients (59% female; 76% rural), the proportions with good SMBG adherence were 34%, 17%, 15% and 10% during 0-6, 7-12, 13-18 and 19-24 months into the HGM program respectively. In multivariate analysis, male gender, urban place of residence and payment for glucostrips were associated with poor adherence during 0-12 months. The mean reduction in HbA1c compared to baseline was 1.2%, 1.1%, 0.8% and 0.7% at 6, 12, 18 and 24 months, respectively. We did not find any association between SMBG adherence and glycemic control.


Adherence to SMBG was sub-optimal, especially among those who had to pay for glucostrips. Patient education and provision of free glucostrips are recommended to improve adherence and glycemic control.


Adherence; DM; Gglycemic control; Self-monitoring of blood glucose

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