Population Attributable Fraction of Associated Factors to Adherence to Blood Glucose Self-Monitoring in Diabetic Type 2 Patients Treated With Insulin or Sulfonylureas/Meglitinides: The Results of Diacare Study in Iran Publisher



Mohammadi A ; Shafiee G ; Olyaeemanesh A ; Daroudi R ; Aghakhani A ; Nasliesfahani E ; Razi F ; Heshmat R ; Takian A
Source: Journal of Education and Health Promotion Published:2026

Abstract

BACKGROUND: Self-monitoring of blood glucose (SMBG) is a part of diabetes management. Numerous investigations have demonstrated inadequate adherence to SMBG. We investigated the level of adherence to SMBG in diabetic type 2 patients treated with insulin or sulfonylureas/meglitinide and the population attributable fraction of associated factors to SMBG in Iran. MATERIALS AND METHODS: This cross-sectional study used data from the population-based study on diabetes care in Iran (DiaCare). Overall, 13392 diabetic persons aged 35–75 years were recruited from urban/rural areas of all 31 provinces of Iran in the DiaCare study. Our samples in the current study consisted of 7,481 individuals who were administered insulin or oral medications required to undertake SMBG. The patients were divided into two groups: the adherence group was those who used insulin and were required to perform SMBG at least twice per day or those who relied on oral medications (sulfonylureas/meglitinides) who were expected to engage in SMBG at least twice a week. Patients who did not meet these requirements were categorized as the nonadherence group. Univariate comparisons and multivariate logistic regression were used to assess the relationships between SMBG adherence and related factors and to calculate the population attributable fraction (PAF); the complex survey design was taken into consideration. RESULTS: A total of 17.8% (1096/7481) of patients were seen to adhere to the SMBG. However, the rate of SMBG adherence was 38.8 percent in patients who used sulfonylureas/meglitinides; only 3.26% of patients on insulin were SMBG adherent. The adherence rates for men and women and also age groups were not statistically significant. The adherence rate in urban regions was 19.31%, while in rural areas, it was 11.51%. The multivariable analysis revealed that the probability of performing SMBG is much higher among married patients (OR = 1.84, 95% CI: 1.05,3.21). In addition, the factors of urbanization (OR = 1.79, 95% CI = 1.15-2.78), university education (OR = 1.99, 95% CI: 1.12, 3.55), and no smoking (OR = 1.78, 95% CI = 1.11,2.86) were also positively associated with the possibility of doing SMBG. Being married showed the highest PAF (PAF = 42.74%), followed by not smoking (PAF = 39.41%) and living in urban areas (PAF = 38.46%). Having an education higher than high school demonstrated the lowest PAF (PAF = 8.78%). CONCLUSIONS: Most patients did not adhere to the suggested practice of SMBG. Factors such as marriage, urbanization, university education, and no smoking were shown to be associated with adherence to SMBG with high PAF. We advocate further qualitative and exploratory research to examine the underlying causes of nonadherence to SMBG in Iran. © 2026 Journal of Education and Health Promotion.