Implementation of self-monitoring of blood glucose for patients with insulin-dependent diabetes at a rural non-communicable disease clinic in Neno, Malawi
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i2.16643Keywords:
NCD, UrbanisationAbstract
Background. Self-monitoring of blood glucose (SMBG) is a widely accepted standard of practice for management of insulin-dependent
diabetes, yet is largely unavailable in rural sub-Saharan Africa (SSA). This prospective cohort study is the first known report of
implementation of SMBG in a rural, low-income country setting.
Objectives. To evaluate adherence and change in clinical outcomes with SMBG implementation at two rural hospitals in Neno, Malawi.
Methods. Forty-eight patients with type 1 and insulin-dependent type 2 diabetes were trained to use glucometers and logbooks. Participants
monitored preprandial glucose daily at rotating times and overnight glucose once a week. Healthcare providers were trained to evaluate
glucose trends, and adjusted insulin regimens based on results. Adherence was measured as the frequency with which patients checked and
documented blood glucose at prescribed times, while clinical changes were measured by change in glycated haemoglobin (HbA1c) over a
6-month period.
Results. Participants brought their glucometers and logbooks to the clinic 95 - 100% of the time. Adherence with measuring glucose values
and recording them in logbooks eight times a week was high (mean (standard deviation) 69.4% (15.7) and 69.0% (16.6), respectively). Mean
HbA1c decreased from 9.0% (75 mmol/mol) at enrolment to 7.8% (62 mmol/mol) at 6 months (mean difference 1.2% (95% confidence
interval (CI) 0.6 - 2.0; p=0.0005). The difference was greater for type 1 diabetes (1.6%; 95% CI 0.6 - 2.7; p=0.0031) than for type 2 diabetes
(0.9%; 95% CI 0.1 - 1.9; p=0.0630). There was no documented increase in hypoglycaemic events, and no hospitalisations or deaths occurred.
Conclusion. SMBG is feasible for patients with insulin-dependent diabetes in a rural SSA population, and may be associated with improved
HbA1c levels. Despite common misconceptions, all patients, regardless of education level, can benefit from SMBG. Further research on
long-term retention of SMBG activities and the benefits of increasing frequency of monitoring is warranted.
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Copyright (c) 2023 T Ruderman, G Ferrari, F Valeta, M Boti, K Kumwenda, P H Park, G Ngoga, E Ndarama, E Connolly, G Bukhman, A Adler
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