Associated Factors with Adherence to Self-monitoring of Blood Glucose in Type 1 Diabetes in the First Two Decade of Person Life in Iran

Abstract

Background: People diagnosed with type 1 diabetes are susceptible to a myriad of complications associated with the condition. Self-monitoring of blood glucose (SMBG) levels is paramount in mitigating acute, sub-acute, and chronic complications of diabetes. Objectives: This study aimed to assess the factors associated with adherence to SMBG in individuals with type 1 diabetes during the first two decades of life in Iran. Methods: This cross-sectional study was conducted on 275 people who had type 1 diabetes during the first two decades of their life (children and adolescents) and were referred to the diabetes clinic at Taleghani Hospital, Kermanshah, Iran, from June 2022 to December 2023. The data were analyzed using descriptive and bivariate statistical analyses with SPSS software. Results: Most of the children participating in the study were boys (54.4%), and their average age was 10.48 ± 3.63 years. A total of 53.4% of patients checked their blood glucose with a glucometer more than four times daily. Based on Spearman's correlation test, there was an inverse and significant relationship between the number of times blood glucose was evaluated with a glucometer in the last week and HbA1c (r = -0.340, P = 0.001). Also, with an increasing number of blood glucose assessments with a glucometer in the previous month, HbA1c decreased (r = -0.406, P = 0.001). As a result of the binary logistic regression analyses, it was determined that the variables of age 2 - 6 years (OR: 1.765; CI: 1.240 - 3.011), duration of diabetes > 6 years (OR: 1.303; CI: 1.109 - 2.087), housewife mothers (OR: 1.982; CI: 1.045 - 4.520), having insurance (OR: 4.750; CI: 1.238 - 21.675), high price of strips and glucometers in the market (OR: 0.324; CI: 0.213 - 0.745), and their availability (OR: 0.456; CI: 0.157 - 0.965) were statistically significant with adherence to SMBG in type 1 diabetes. Conclusions: The findings underscore a significant inverse relationship between the frequency of blood glucose monitoring (via glucometer) and HbA1c levels, reinforcing the clinical importance of regular SMBG in achieving glycemic control. Notably, socioeconomic barriers — such as the high cost and limited availability of glucometers and strips — emerged as pivotal obstacles to adherence, highlighting systemic challenges in resource-constrained settings. These findings advocate for policy reforms to subsidize diabetes supplies, improve insurance coverage, and strengthen supply chains for glucometers and strips.