The psychological experiences of self-monitoring blood glucose in people with type 2 diabetes

Abstract

Self-monitoring blood glucose (SMBG) in people with type 2 diabetes has been widely researched. SMBG informs patients of the level of glucose in the blood to enable them to modify lifestyle behaviours to reduce glucose to a healthy level. There is conflicting evidence of the impact of SMBG on patients and on clinical outcomes in people with non-insulin dependent type 2 diabetes and few studies have explored patients’ experience. This thesis presents a systematic review and qualitative study. The aim of the systematic review in Chapter 2, was to explore what is known about patients’ emotional experience of the impact of SMBG, in people newly diagnosed with non-insulin dependent type 2 diabetes. The search yielded a total of 979 studies, only 6 of which met inclusion criteria. Narrative synthesis was conducted to explore participant narratives to form a trustworthy story (Popay et al., 2006). Narrative synthesis revealed 3 predominant themes in patients’ experience of SMBG, ‘search for meaning’, ‘emotional response’ and ‘coping’. Findings highlighted the importance of health care professional support on SMBG when patients search for meaning of blood glucose levels. Lack of support impacts negatively on patients’ emotional response to blood glucose levels making it difficult to adopt appropriate coping strategies. Further research was required as only 3 studies explored experiences of patients newly diagnosed to understand the implications for clinical practice. The aim of the study in chapter 3, was to explore the emotional psychological impact of SMBG in patients newly diagnosed with non-insulin type 2 diabetes after attending structured diabetes education. 33 adults, 12 female and 21 males, consented to participate. A qualitative study design was applied using semi-structured interviews and thematic analysis to gain a rich account of participant experiences and identify and analyse themes in the data (Braun & Clarke, 2006; Clarke & Braun, 2013). Analysis identified 4 overarching categories which were used to structure 11 themes and 33 sub-themes. The categories relating to experience of SMBG were: positive feelings; negative feelings; barriers and facilitators. Findings supported the systematic review that a negative emotional response is triggered by lack of support and feedback on SMBG. The common sense model was applied to the findings which helped to understand participants’ experience. If participants were not supported in the initial stage when patients develop illness representations of blood glucose, this exacerbated negative emotional responses of worry, causing a barrier to adopting coping strategies. The findings also identified positive feelings associated directly to SMBG of reassurance, feeling confident with food and feeling in control. Barriers and facilitators for effective SMBG were identified by participants which adds to the literature with potential suggestions for clinical practice to improve the experience of SMBG with the aim of improving health behaviour change and self-regulation blood glucose levels. The limitations of the qualitative nature of the evidence presented are acknowledged for making definitive clinical recommendations.

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ORCID for Cynthia Graham: orcid.org/0000-0002-7884-599X

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