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The impact of limited and strategic blood glucose monitoring on metabolic control in a type 1 diabetes clinic in Central India

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Self-monitoring of blood glucose (SMBG) is an essential component of type 1 diabetes (T1D) management and typically involves several daily tests. However, due to high cost, SMBG supplies are often unavailable in low-resource settings. This study assessed whether the use of two SMBG tests per day improves glycemic control, measured by a change in HbA1c, in youth with T1D followed at the DREAM Trust (DT) in Nagpur, India.


Single-site prospective cohort study of youth ≤ 23 years of age with T1D ≥ 1 year followed by DT, who were provided with SMBG meters and two test strips per day. Patients received education regarding SMBG and how to respond to blood glucose values and trends. They were followed every 3 months with HbA1c and questionnaires for a total of 21 months.


HbA1c declined significantly from 10.2 ± 2.5% (88 ± 4 mmol/mol) at baseline to 9.5 ± 2.4% (80 ± 3 mmol/mol) at 21 months (p < 0.001). In univariable analysis, change in HbA1c was associated with adherence to insulin dosing, number of patient education sessions, household income, and holding a below the poverty line certificate. In multivariable analysis, only adherence to insulin dosing was a significant predictor for a decrease in HbA1c. There was no increase in diabetes-related acute complications.


The use of two SMBG test strips per day for the management of T1D in a low-resource setting was safe, and over the 21 months following its introduction, there was a clinically and statistically significant decrease in HbA1c.

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  1. DiMeglio LA, Acerini CL, Codner E, Craig ME, Hofer SE, Pillay K, et al. ISPAD Clinical Practice Consensus Guidelines 2018: glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes. 2018;19(Suppl 27):105–14.

    Article  Google Scholar 

  2. Klatman EL, Jenkins AJ, Ahmedani MY, Ogle GD. Blood glucose meters and test strips: global market and challenges to access in low-resource settings. Lancet Diabetes Endocrinol. 2019;7(2):150–60.

    Article  Google Scholar 

  3. Zuijdwijk C, Pendsey S, Ron J, Williams K, Akiki S, Chalkhore S, et al. Management of type 1 diabetes in a limited resource context: a study of the diabetes research education and management trust model in Nagpur. Cent India J Diabetol. 2017;8(2):37–44.

    Article  Google Scholar 

  4. Jain SK. Identification of the poor. Econ Polit Wkly. 2004;39(46–47):4981–4 Available at (accessed March 2, 2020).

    Google Scholar 

  5. Team RC. R: a language and environment for statistical computing. R Foundation for Statistical Computing: Vienna; 2017.

    Google Scholar 

  6. Ziegler R, Heidtmann B, Hilgard D, Hofer S, Rosenbauer J, Holl R, et al. Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2011;12(1):11–7.

    Article  Google Scholar 

  7. Miller KM, Beck RW, Bergenstal RM, Goland RS, Haller MJ, McGill JB, et al. Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A1c levels in T1D exchange clinic registry participants. Diabetes Care. 2013;36(7):2009–14.

    Article  Google Scholar 

  8. Pastakia SD, Cheng SY, Kirui NK, Kamano JH. Dynamics, impact, and feasibility of self-monitoring of blood glucose in the rural, resource-constrained setting of Western Kenya. Clin Diabetes. 2015;33(3):136–43.

    Article  Google Scholar 

  9. Noorani M, Ramaiya K, Manji K. Glycaemic control in type 1 diabetes mellitus among children and adolescents in a resource limited setting in Dar es Salaam - Tanzania. BMC Endocr Disord. 2016;16(1):29.

    Article  Google Scholar 

  10. Altamirano-Bustamante N, Islas-Ortega L, Robles-Valdes C, Garduno-Espinosa J, Morales-Cisneros G, Valderrama A, et al. Economic family burden of metabolic control in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2008;21(12):1163–8.

    Article  Google Scholar 

  11. Gomes MB, Tannus LR, Cobas RA, Matheus AS, Dualib P, Zucatti AT, et al. Determinants of self-monitoring of blood glucose in patients with type 1 diabetes: a multi-centre study in Brazil. Diabet Med. 2013;30(10):1255–62.

    Article  CAS  Google Scholar 

  12. Davey B, Segal DG. Self-monitoring of blood glucose measurements and glycaemic control in a managed care paediatric type 1 diabetes practice. S Afr Med J. 2015;105(5):405–7.

    Article  CAS  Google Scholar 

  13. Chopra A, Sudhanshu S, Chen Y, Mangla P, Dabadghao P, Bhatia E, et al. The impact of free medical supplies and regular telephonic contact on glycemic control in Indian children and adolescents with type 1 diabetes. Pediatr Diabetes. 2019;20(4):444–9.

    Article  Google Scholar 

  14. Ogle GD, von Oettingen JE, Middlehurst AC, Hanas R, Orchard TJ. Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels. Pediatr Diabetes. 2019;20(1):93–8.

    PubMed  Google Scholar 

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The International Diabetes Federation (IDF) Life for a Child program provided funding for HbA1C measurement, database creation, and statistical support.

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Authors and Affiliations



Caroline Zuijdwijk was involved in study conception and design, data interpretation, and writing the manuscript. Sharad Pendsey was involved in study conception and design and facilitated the collection of data in his clinic. James Ron was involved in study conception and design, as well as data interpretation. Graham Ogle provided scholarly input and was involved in data interpretation. Amisha Agarwal and Nick Barrowman were involved in data analysis and interpretation. Seema Chalkhore and Sanket Pendsey were involved in study design, as well as data collection and recording. Alexandra Ahmet was involved in study conception and design and data interpretation. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

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Correspondence to Caroline S. Zuijdwijk.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all participants by DT staff. If participants were too young to consent to study participation, informed consent was obtained from their parents/ legal guardians, and assent was obtained from the child.

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Zuijdwijk, C.S., Pendsey, S., Ron, J. et al. The impact of limited and strategic blood glucose monitoring on metabolic control in a type 1 diabetes clinic in Central India. Int J Diabetes Dev Ctries 40, 578–584 (2020).

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