Analysis of factors influencing blood glucose self-monitoring behavior in patients with gestational diabetes mellitus and construction of its prediction model

Yanfei Zhu, Jing Zhou, Xiaoe Xie, Chenyang Ding, Chunmei Zhu, Yayan Li, Ping Lan

Abstract

The objective of this study was to investigate the factors influencing self-monitoring of blood glucose (SMBG) behavior in patients with gestational diabetes mellitus (GDM) and to develop a predictive model for clinical intervention. The method of this study was to divide 587 GDM patients admitted to Lishui Maternal and Child Health Hospital from May 2020 to June 2023 into training group (n = 410) and test group (n = 177) by using R 4.3.2 in a ratio of 7:3. The training set cases were divided into target group (n = 109) and non-target group (n = 301) according to whether SMBG was met (monitoring fasting or postprandial 2 h blood glucose 2-4 times per week).Key factors affecting SMBG were identified through univariate analysis and logistic regression, including education level, family income, glucometer possession, and dimensions of the Information-Motivation-Behavior (IMB) model. A nomogram prediction model was developed, with Area Under the Curve (AUC) values of 0.863 and 0.829 in the training and testing cohorts, respectively, demonstrating good predictive performance. The calibration curve confirmed the accuracy of the model. The findings suggest that SMBG behavior in GDM patients is influenced by socioeconomic and psychological factors, and the developed model provides a valuable tool for clinical assessment and intervention.

Full Text:

PDF

References

Hu H, Feng P, Yu Q, Zhu W, Xu H, Wu D, Wu L, Yin J and

Li H. The mediating role of gestational diabetes

mellitus in the associations of maternal prepregnancy

body mass index with neonatal birth weight. J

Diabetes. 2022 Jan;14(1):26-33. doi: 10.1111/1753

13233.

Sweeting A, Wong J, Murphy HR and Ross GP. A Clinical

Update on Gestational Diabetes Mellitus. Endocr

Rev.

Sep

1210/endrev/bnac003.

;43(5):763-793.

doi:

Davis EM, Abebe KZ, Simhan HN, Catalano P, Costacou T,

Comer D, Orris S, Ly K, Decker A, Mendez D, Day

N and Scifres CM. Perinatal Outcomes of Two

Screening Strategies for Gestational Diabetes

Mellitus: A Randomized Controlled Trial. Obstet

Gynecol.

Jul

;138(1):6-15.

doi:

1097/AOG.0000000000004431.

Mijatovic-Vukas J, Capling L, Cheng S, Stamatakis E, Louie

J, Cheung NW, Markovic T, Ross G, Senior A,

Brand-Miller JC and Flood VM. Associations of Diet

and Physical Activity with Risk for Gestational

Diabetes Mellitus: A Systematic Review and Meta

Analysis. Nutrients. 2018 May 30;10(6):698. doi:

3390/nu10060698.

Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational diabetes

mellitus

and adverse pregnancy outcomes:

systematic review and meta-analysis. BMJ. 2022

May 25;377:e067946. doi: 10.1136/bmj-2021

Seyhanli Z, Seyhanli A, Aksun S and Pamuk BO. Evaluation

of serum Angiopoietin-like protein 2 (ANGPTL-2),

Angiopoietin-like protein 8 (ANGPTL-8), and high

sensitivity C-reactive protein (hs-CRP) levels in

patients with gestational diabetes mellitus and

normoglycemic pregnant women. J Matern Fetal

Neonatal Med. 2022 Dec;35(25):5647-5652. doi:

1080/14767058.2021.1888919.

American Diabetes Association. Standards of Medical Care in

Diabetes-2021 Abridged for Primary Care Providers.

Clin

Diabetes.

2337/cd21-as01.

Jan;39(1):14-43. doi:

Tian Y, Zhang S, Huang F, Shi F, Li Y, Chen X, Zhang C,

Zhong H, Ma W, Liu C, Niu C, Xue X and Ma L.

Glycemic qualification rate and frequency of self

monitoring blood glucose glycemic qualification rate

and frequency of self-monitoring blood glucose

(SMBG) in women with gestational diabetes mellitus

(GDM). Diabetes Res Clin Pract. 2020

Dec;170:108482.

doi:

1016/j.diabres.2020.108482. Epub 2020 Sep 28.

Cosson E, Baz B, Gary F, Pharisien I, Nguyen MT, Sandre

Banon D, Jaber Y, Cussac-Pillegand C, Banu I,

Carbillon L, Valensi P. Poor Reliability and Poor

Adherence to Self-Monitoring of Blood Glucose Are

Common in Women With Gestational Diabetes

Mellitus and May Be Associated With Poor

Pregnancy Outcomes. Diabetes Care. 2017

Sep;40(9):1181-1186. doi: 10.2337/dc17-0369.

Diagnostic criteria and classification of hyperglycaemia first

detected in pregnancy: a World Health Organization

Guideline. Diabetes Res Clin Pract. 2014

Mar;103(3):341-63.

doi:

1016/j.diabres.2013.10.012.

Bao Y, Chen L, Chen L, Dou J, Gao Z, Gao L, Guo L, Guo

X, Ji L, Ji Q, Jia W, Kuang H, Li Q, Li Q, Li X, Li

Y, Li L, Liu J, Ma J, Ran X, Shi L, Song G, Wang Y,

Weng J, Xiao X, Xie Y, Xi G, Yang L, Zhao Z, Zhou

J, Zhou Z, Zhu D and Zou D; Chinese Diabetes

Society. Chinese clinical guidelines for continuous

glucose monitoring (2018 edition). Diabetes Metab

Res

Rev.

1002/dmrr.3152.

Sep;35(6):e3152.

doi:

Gao J, Wang J, Zhu Y and Yu J. Validation of an

information-motivation-behavioral skills model of

self-care among Chinese adults with type 2 diabetes.

BMC Public Health. 2013 Feb 4;13:100. doi:

1186/1471-2458-13-100.

Wang X, Luo JF, Qi L, Long Q, Guo J and Wang HH.

Adherence to self-monitoring of blood glucose in

Chinese patients with type 2 diabetes: current status

and influential factors based on electronic

questionnaires. Patient Prefer Adherence. 2019 Jul

;13:1269-1282. doi: 10.2147/PPA.S211668.

Zhang CH and Zhang PL. Adverse perinatal outcomes

complicated with gestational diabetes mellitus in

preterm mothers and preterm infants. Exp Ther Med.

Jul

3892/etm.2023.12124.

;26(3):425.

doi:

Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D,

Golder S and Lawlor DA. Treatments for gestational

diabetes: a systematic review and meta-analysis.

BMJ Open. 2017 Jun 24;7(6):e015557. doi:

1136/bmjopen-2016-015557.

Guo J, Long Q, Li J, Wang X, Li Y, Jiang S, Sun M, Wiley J

and Chen JL. Barriers and facilitators of self

monitoring of blood glucose engagement among

women with gestational diabetes mellitus in China:

A mixed-methods study. Midwifery. 2020

Nov;90:102797. doi: 10.1016/j.midw.2020.102797.

Adams AS, Mah C, Soumerai SB, Zhang F, Barton MB and

Ross-Degnan D. Barriers to self-monitoring of blood

glucose among adults with diabetes in an HMO: a

cross sectional study. BMC Health Serv Res. 2003

Mar 19;3(1):6. doi: 10.1186/1472-6963-3-6.

Chertok IRA, Silk JJ and Kulasa KA. Perspectives on

Barriers and Facilitators in Caring for Women with

Gestational Diabetes in Rural Appalachia. MCN Am

J Matern Child Nurs. 2019 Sep/Oct;44(5):289-295.

doi: 10.1097/NMC.0000000000000552.

Chen M, Yun Q, Lin H, Liu S, Liu Y, Shi Y, Ji Y and Chang

C. Factors Related to Diabetes Self-Management

Among Patients with Type 2 Diabetes: A Chinese

Cross-Sectional

Survey

Based

on

Self

Determination Theory and Social Support Theory.

Patient Prefer Adherence. 2022 Apr 6;16:925-936.

doi: 10.2147/PPA.S335363.

Lv W, Luo J, Long Q, Yang J, Wang X and Guo J. Factors

Associated with Adherence to Self-Monitoring of

Blood Glucose Among Young People with Type 1

Diabetes in China: A Cross-Sectional Study. Patient

Prefer Adherence. 2021 Dec 14;15:2809-2819. doi:

2147/PPA.S340971.

Yuan L, Guo X, Xiong Z, Lou Q, Shen L, Zhao F, Sun Z and

Li J. Self-monitoring of blood glucose in type 2

diabetic patients in China: current status and

influential

factors.

;127(2):201-7.

Chin Med J (Engl).

Mak WH and Lau RW. Predictors of self-monitoring of

blood glucose among noninsulin-treated patients

with type 2 diabetes in a primary care setting in Hong

Kong: A cross-sectional study. SAGE Open Med.

Dec

;9:20503121211066150.

1177/20503121211066150.

doi:

Al-Keilani MS, Almomani BA, Al-Sawalha NA and Shhabat

BA. Self-monitoring of blood glucose among

patients with diabetes in Jordan: Perception,

adherence, and influential factors. Diabetes Res Clin

Pract.

Apr;126:79-85.

1016/j.diabres.2017.01.005.

doi:

Li YH, Wang YJ and Liu G. [Analysis of blood glucose

control and influencing factors in 18-64 year-old

community people with type 2 diabetes in

Shenzhen]. Zhonghua Liu Xing Bing Xue Za Zhi.

Oct 10;45(10):1419-1425. Chinese. doi:

3760/cma.j.cn112338-20240516-00277.

Yao J, Wang H, Yan J, Shao D, Sun Q and Yin X.

Understanding the Profiles of Blood Glucose

Monitoring Among Patients with Type 2 Diabetes

Mellitus: A Cross-Sectional Study in Shandong,

China. Patient Prefer Adherence. 2021 Feb

;15:399-409. doi: 10.2147/PPA.S292086.

Alayoub H, Curran S, Coffey M, Hatunic M and Higgins M.

Assessment of the effectiveness of group education

on knowledge for women with newly diagnosed

gestational

diabetes. Ir J Med Sci. 2018

Feb;187(1):65-68. doi: 10.1007/s11845-017-1609-9.

Keygan, J. "The impact of gestational diabetes mellitus on

the pregnant women, her infant and family,

midwifery practice and the health care system."

Nuritinga 12 (2013): 12-23.

Refbacks

  • There are currently no refbacks.