Compliance and barriers to self-monitoring of blood glucose in patients with gestational diabetes mellitus: A systematic review

OBJECTIVE: This study intends to understand the barriers to self-monitoring of blood glucose (SMBG) in gestational diabetes mellitus (GDM) patients. In addition, it also aims to know the factors that influence the compliance with SMBG-testing among GDM patients. METHODS: The study primarily comprised a search of various databases (PubMed, EMBASE, SCOPUS, PsycINFO, PROQUEST, and CINAHL). Research papers published between March 2010 and June 2018 were searched for this review. Article types considered for this review were observational studies, experimental studies, and systemic reviews with or without meta-analysis. Using a set of eligibility criteria; initially, the papers were scrutinized by reviewing the abstracts, following which a full-text review of the selected papers was undertaken. Finally, a critical appraisal and an overall qualitative assessment of these studies were done. RESULTS: Literature search identified 25 papers, excluding the duplicates. Six studies (two qualitative and four quasi-experimental) that matched the eligibility criteria of this study were reviewed. The barriers of SMBG in GDM patients were non-prescription of SMBG by the health-care providers, poor perception and fear of SMBG, and family history of Type 2 diabetes. Use of smartphone technology and SMBG-education improved the compliance to SMBG testing. However, most of the quasi-experimental studies did not have a pre- and post-intervention comparison of their results or comparison of their findings with any control group. Moreover, the way of determining compliance among three of these studies was not identical. Similarly, among the qualitative studies, one study does not have a clear mention of the language in which the interviews were conducted, whereas the other qualitative study does not state, if the English language translation of the verbatim transcripts was validated or not. Only one study mentioned the diagnostic criteria used to diagnose GDM. CONCLUSION: The recent evidence to the barriers of SMBG and the factors that influence the compliance of SMBG is weak and not generalizable. Moreover, there is a scarcity of literature that addresses the context.