Social, political and economic implications of self-blood glucose monitoring in type 2 diabetes management

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Background: Globally the burden of diabetes is increasing. Self-monitoring of blood glucose (SMBG) has been recommended as part of diabetes management, irrespective of treatment, for 50 years. There is evidence that SMBG does not clinically improve glycaemic control in all patients with non-insulin treated type 2 diabetes (NITT2DM). Funding and practice models are influenced by stakeholders, including industry and patient advocacy groups. Yet how Australian HCPs formulate their views regarding SMBG has not been studied. Aim: This research is designed to inform our understanding of the factors that influence Australian HCP’s perceived value of SMBG for patients with NITT2DM and to review the evidence for SMBG analysing social, political and economic trends influencing recommendations. Method: Following a review of evidence and detailed review of policy documents, using a Qualitative Descriptive method, qualitative semi-structured interviews were undertaken with Australian HCPs to obtain insight into their beliefs and practices relating to SMBG in patients with NITT2DM. The perceptions about the value of monitoring, why and how HCPs form these views, and the ways they use the results were examined. Moreover, the type and source of the education and training of HCPs were identified. Results: A qualitative approach thematic analysis of the data resulted in key insights from 25 interviews with diabetes educators, pharmacists, endocrinologists, general practitioners, dietitians and primary care nurses. Seven main themes emerged from the analysis: (1) The perceived value of SMBG in people with diabetes varies within and between health professional groups; (2) The information patients receive about SMBG is limited; (3) SMBG is not a benign activity and can have negative consequences; (4) The health care professionals most likely to use the results in a purposeful manner are diabetes educators and dietitians; (5) the capacity to provide specialised training to patients is limited; (6) Professional training does not address SMBG; and (7) HCPs want impartial information about SMBG. Conclusions: This thesis demonstrated that the views of HCPs are varied and largely based on inconsistent information, training as well as the influence of marketing, and other key stakeholder groups. The consequences of these actions have implications for the health care system, provider and patients. Inconsistent recommendations to patients contribute to adverse health care outcomes and rising health care costs. These findings provide an empirical basis to inform educational and policy interventions to help ensure that training and recommendations regarding SMBG are standardised and evidence-based.
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