Invasiveness as a barrier to self-monitoring of blood glucose in diabetes

Diabetes Technol Ther. 2005 Aug;7(4):612-9. doi: 10.1089/dia.2005.7.612.


Background: This study investigated the degree to which the invasive characteristic of glucose monitoring is a barrier to self-monitoring of blood glucose (SMBG).

Methods: A paper-and-pencil Measure of Invasiveness as a reason for Skipping SMBG (MISS) was created and administered to 339 people with diabetes. The correlations between MISS scores and actual SMBG frequency, percent adherence to SMBG recommendations, SMBG anxiety, SMBG burden, and knowledge of the importance of glycemic control for avoiding diabetes complications were each explored.

Results: On a scale of 0-28, the average MISS score was M = 4.3 (SD = 5.4, range 0-28). Fully 63% (nearly two-thirds) of respondents reported skipping SMBG because of the invasiveness of the procedure. MISS scores were negatively related to percent adherence to healthcare provider SMBG recommendations as measured by memory function of automated meters (Spearman's r= -0.47, P < 0.01). MISS scores were also negatively related to absolute SMBG frequency regardless of SMBG recommendations (Spearman's r= -0.11, P < 0.05). Correlation between the MISS and SMBG anxiety was significant (Spearman's r = 0.50, P < 0.01). With highly anxious participants deleted, the magnitude of the correlation was attenuated, but persisted (Spearman's r = 0.28, P < 0.01), suggesting that invasiveness is associated with SMBG anxiety even among patients without a blood or injection phobia. MISS scores were also correlated with the degree to which patients find routine and non-routine SMBG checks a burden (routine r = 0.38, P < 0.01; non-routine r = 0.45, P < 0.01). Results of Mann-Whitney U tests indicated higher MISS scores among participants with less knowledge about the importance of glycemic control in the development of diabetes vascular complications.

Conclusions: Invasiveness is a common and serious barrier to SMBG. These findings suggest that people with diabetes would perform SMBG more frequently and have improved quality of life with non-invasive SMBG.

MeSH terms

  • Anxiety*
  • Blood Glucose Self-Monitoring / adverse effects*
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 1 / psychology*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / psychology*
  • Fear*
  • Humans
  • Injections, Subcutaneous / adverse effects*
  • Insulin / administration & dosage
  • Insulin / therapeutic use
  • Middle Aged
  • Surveys and Questionnaires


  • Insulin