PDB42 ADHERENCE TO ROUTINE OR STRUCTURED GLUCOSE MONITORING: A QUALITATIVE EVALUATION FROM THE STEP STUDY

Evidence regarding the value and utility of SMBG in insulin-naïve type 2 diabetes (T2DM) has been mixed. Failure to personally understand the value associated with SMBG results and/or share SMBG data with healthcare providers (HCPs) may contribute to poor treatment adherence. The Structured Testing Program (STeP) study, a prospective, cluster-randomized, multi-centered clinical trial, demonstrated that structured SMBG significantly improves glycemic control and quality of life in non-insulin-treated T2DM. In the study, 483 poorly-controlled (HbA1c ≥7.5%), insulin-naïve T2DM patients were randomized to structured testing (STG) or active control (ACG). All STG and ACG patients received free blood glucose meters and test strips. STG subjects also used the ACCU-CHEK® 360 View Blood Glucose Analysis System (”tool”) quarterly to collect/interpret 7-point glucose profiles over 3 consecutive days. STG patients then brought the tool to their HCPs. To evaluate STeP study patient perceptions regarding diabetes self-management and interactions with HCPs. A qualitative descriptive design; data were collected via phone interviews with 59 (20 ACG, 39 STG) STeP study participants. Data were analyzed using a content analysis approach. Sample characteristics included: 54% male; 56% White; mean age 57.1 years; 49% some college or more; mean duration of T2DM 7.4 years; and mean baseline HbA1c 8.9%. Although participants from both study arms perceived SMBG as having personal value, STG patients reported additional benefits of using the tool, including: more in-depth understanding of diabetes; increased confidence in daily decision-making; more meaningful discussions with HCPs; and shared decision-making regarding treatment. Our findings suggest that use of structured testing, as part of a comprehensive intervention where patients and HCPs collaborate to gather, interpret and utilize SMBG data, promotes a positive change in how patients view SMBG, improves patient comprehension of diabetes and diabetes self-management, and increases patient participation in their treatment regimens.