Determinants of self-monitoring adherence in type 2 diabetes: bridging the gap in patient care

Background and aim: Self-monitoring of blood glucose (SMBG) is a key component of type 2 diabetes mellitus (T2DM) management; however, adherence to recommended practices remains suboptimal. This study aimed to assess SMBG adherence among patients with T2D attending a tertiary diabetes center in Jordan and to identify factors associated with adherence. Methods: A cross-sectional study was conducted among adults with T2DM attending the National Center for Diabetes, Endocrinology, and Genetics in Amman, Jordan, between November 2022 and January 2023. Demographic and clinical data were obtained from medical records, and SMBG adherence was assessed using a validated Arabic self-reported questionnaire. Descriptive statistics summarized adherence patterns, and multivariable regression analyses were performed to identify factors independently associated with SMBG adherence. Results: Among 805 eligible participants enrolled in the study, 539 (67.0%) reported performing SMBG and were included in the adherence and practice analyses. Of these, 255 (47.3%) met the criteria for adherence to the SMBG recommendations adopted for this study. Adherence was highest among patients treated with oral hypoglycemic agents (55.3%) and lower among those receiving combined oral and insulin therapy (38.9%) or insulin alone (40.0%). SMBG was predominantly symptom-driven, and daily monitoring was uncommon. In adjusted analyses, adherence was significantly lower among patients using combined oral and insulin therapy (OR = 0.393) or insulin alone (OR = 0.425) compared with oral therapy alone. Higher adherence was independently associated with the presence of chronic kidney disease (OR = 1.789) and diabetic neuropathy (OR = 2.691). Perceived usefulness of SMBG emerged as the strongest predictor of adherence (OR = 5.741). Conclusion: Adherence to self-monitoring of blood glucose (SMBG) among patients with type 2 diabetes mellitus was suboptimal and largely symptom-driven. Adherence varied by treatment modality and the presence of diabetes-related complications and was strongly influenced by patients' perceived usefulness of SMBG. Targeted education and individualized SMBG recommendations are needed to improve adherence in routine diabetes care.