JMIR Publications

ABSTRACT

Background:

Self-monitoring of blood glucose (SMBG) and insulin dose self-adjustment are cornerstones of diabetes self-management that help improve glycemic control and prevent diabetes complications. However, many patients struggle with long-term adherence to SMBG practices, resulting in poor glycemic control.

Objective:

This study aimed to explore the experiences and determinants of sustained SMBG adherence and insulin dose self-adjustment among patients with diabetes mellitus, guided by the Social Ecological Model (SEM).

Methods:

A qualitative study was conducted between September 2024 and March 2025 in four primary care clinics, involving 14 patients with type 2 diabetes mellitus who were receiving insulin therapy. Data were collected through semi-structured interviews, audio-recorded and transcribed verbatim. Thematic analysis was performed with the aid of NVivo 14 software.

Results:

Three main themes described patient’s experiences: perceived purpose of SMBG, practice of SMBG with insulin dose adjustment, and patient preferences of SMBG education. Patients performed SMBG to gain awareness of their glucose status. The SMBG readings guide self-regulatory actions and shapes expectations of health outcomes. SMBG practices ranged from regular monitoring to symptom-driven or random checks, with insulin dose adjustments based on individual interpretation of readings. Patients also expressed a need for clear information on SMBG frequency and insulin dose adjustment procedures, preferring educational materials delivered through printed booklets or digital applications. Four themes of determinants for SMBG adherence sustainability were identified based on SEM framework: (i) individual influences including knowledge and skills, daily routine, health beliefs, financial status, pain associated with SMBG; (ii) interpersonal influences encompassing family and peer support, relationship with healthcare providers; (iii) community/ organizational influences comprising local community activity, social perception; workplace setting and (iv) policy shapes the accessibility of SMBG equipment. SMBG facilitators included adequate education, feel motivated and responsible in doing SMBG and stable financial status. Knowledge gaps, time constraints, limited family or healthcare provider support, negative perception among colleagues, and limited accessibility to SMBG equipment are barriers to sustaining SMBG.

Conclusions:

Patients’ SMBG and insulin dose self-adjustment practices are influenced by multiple, interacting determinants across SEM levels. Effective interventions must holistically address barriers while strengthening facilitators using patient-centered approach to sustain SMBG adherence in primary care.