Educational disparities in the associations between self-monitoring of blood glucose and glycemic control in type 2 diabetes patients in Xiamen, China: 中国厦门市2型糖尿病患者自我血糖监测与血糖控制之间关联的 教育水平差异研究

BACKGROUND: This study examined the combined effects of self-monitoring of blood glucose (SMBG) and educational attainment on glycemic control in type 2 diabetes mellitus (T2DM) patients. METHODS: A cross-sectional survey was performed among community residents with T2DM. Good glycemic control was defined as HbA1c <7% in the most recent measurement. Multivariable logistic regression was used to examine associations of glycemic control with SMBG, educational attainment, and their combined effects by controlling for certain covariates, with further stratification by sex. RESULTS: Complete data were available for 798 patients, of which 58.52% had good glycemic control. Higher education and SMBG were associated with good glycemic control (P < 0.05). In the SMBG group, tertiary-educated patients had the greatest odds of good glycemic control (odds ratios 2.56; 95% confidence interval 1.31-4.99). Among those performing SMBG, the odds of good glycemic control were higher for those with higher education levels (Ptrend  = 0.003), whereas there was no clear trend for those not performing SMBG (Ptrend  = 0.071). For subjects attaining secondary and tertiary education levels, the odds of good glycemic control were higher in those performing SMBG, although there was no significant difference between the two groups for those with a primary education. Glycemic control decreased slightly among males with a primary level education, but showed an increasing trend among females with a primary level education. CONCLUSIONS: Sex-specific educational disparities exist in the association between SMBG and glycemic control. More detailed guidelines for SMBG according to a subject's socioeconomic position and sex are required.