Balancing Need and Feasibility: Stakeholder Insights on Frequent Blood Glucose Monitoring in Indonesia
DOI:
https://doi.org/10.33084/bjop.v8i3.9848Keywords:
blood glucose testing, diabetes mellitus, HbA1C testingAbstract
Patients with type 2 diabetes mellitus require regular evaluation of the medication's effectiveness and safety through blood glucose and HbA1c testing. This continuous monitoring is one of the primary roles of pharmacists in collaboration with physicians and supported by health insurance to examine the fluctuation patterns of blood glucose levels in response to diabetes medications. This study aimed to identify the need and feasibility of frequent blood glucose monitoring from the perspective of physicians, pharmacists, national health insurance officials, and diabetes patients. A qualitative study using semi-structured interviews was conducted in six Public Health Centers and seven pharmacies in Banjarmasin, Indonesia, from November 2022 to September 2023. A total of twenty-one respondents were included in this study. Data were tape-recorded, transcribed verbatim, and categorized using manual thematic content analysis. This study reveals that inappropriate patient conditions, irregular visits to Public Health Centers, patients' negative emotions, limitations in self-monitoring blood glucose, and lack of patients' knowledge create barriers to conducting monitoring of diabetes. On the other hand, the frequent blood glucose and HbA1c testing was supported by positive perceptions of the importance of testing, ease of access, and the active roles of physicians, pharmacists, and insurance officials. The barriers and facilitators of continuous diabetes medication monitoring are key factors that pharmacists, physicians, and insurance officials should consider to ensure that medication effectiveness and safety are monitored effectively.
Downloads
References
Gordon C. Blood glucose monitoring in diabetes: rationale and procedure. Br J Nurs. 2019;28(7):434-9. DOI: 10.12968/bjon.2019.28.7.434; PMID: 30969870
Cannon A, Handelsman Y, Heile M, Shannon M. Burden of Illness in Type 2 Diabetes Mellitus. J Manag Care Spec Pharm. 2018;24(9-a Suppl):S5-13. DOI: 10.18553/jmcp.2018.24.9-a.s5; PMCID: PMC10408423; PMID: 30156443
Prescott J, Page MR, Chou L, Toye J, Costello J, Hernandez G, et al. Challenges in Diabetes Management: Glycemic Control, Medication Adherence, and Healthcare Costs. Am J Manag Care. 2017;8:A773.
American Diabetes Association Professional Practice Committee. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S17-38. DOI: 10.2337/dc22-s002; PMID: 34964875
Dunn TC, Xu Y, Hayter G, Ajjan RA. Real-world flash glucose monitoring patterns and associations between self-monitoring frequency and glycaemic measures: A European analysis of over 60 million glucose tests. Diabetes Res Clin Pract. 2018;137:37–46. DOI: 10.1016/j.diabres.2017.12.015; PMID: 29278709
Mulyanto J, Wibowo Y, Ernawati DA, Lestari DWD, Kringos DS. Exploring Inequalities in the Use, Quality, and Outcome of the Diabetes Management Program of Indonesian National Health Insurance. Heal Equity. 2023;7(1):644–52. DOI: 10.1089/heq.2023.0025; PMCID: PMC10541918; PMID: 37786529
Badan Penyelenggara Jaminan Sosial Kesehatan. Panduan praktis PROLANIS ((Program Pengelolaan Penyakit Kronis). Jakarta: Badan Penyelenggara Jaminan Sosial Kesehatan; 2014.
Khoe LC, Wangge G, Soewondo P, Tahapary DL, Widyahening IS. The implementation of community-based diabetes and hypertension management care program in Indonesia. PLoS One. 2020;15(1):e0227806. DOI: 10.1371/journal.pone.0227806; PMCID: PMC6959571; PMID: 31935256
Rinda AC, Athiyah U, Hermansyah A. Problems in continuity of care for patients with type 2 diabetes mellitus. Pharm Educ. 2023;23(4):238–41. DOI: 10.46542/pe.2023.234.238241
McClurg MR, Sorensen TD, Carroll J. The Patient Care Process for Delivering Comprehensive Medication Management (CMM): Optimizing Medication Use in Patient-Centered, Team-Based Care Settings. Lenexa (KS): CMM in Primary Care Research Team; 2018.
Ewen M, Lepeska M, Abdraimova A, Besançon S, Cham NTP, Dunganova A, et al. Availability, prices and affordability of self-monitoring blood glucose devices: surveys in six low-income and middle-income countries. BMJ Public Health. 2025;3(1):e001128. DOI: 10.1136/bmjph-2024-001128; PMCID: PMC11865750; PMID: 40017936
Rodbard D. Continuous Glucose Monitoring: A Review of Successes, Challenges, and Opportunities. Diabetes Technol Ther. 2016;18(Suppl 2):S3–13. DOI: 10.1089/dia.2015.0417; PMCID: PMC4717493; PMID: 26784127
Wright Jr EE, Gavin 3rd JR. Clinical use of professional continuous glucose monitoring. Diabetes Technol Ther. 2017;19(S2):S12–15. DOI: 10.1089/dia.2017.0037; PMCID: PMC5444501; PMID: 28541135
Miller EM. Using continuous glucose monitoring in clinical practice. Clin Diabetes. 2020;38(5):429–38. DOI: 10.2337/cd20-0043; PMCID: PMC7755046; PMID: 33384468
Oyewole OO, Ale AO, Ogunlana MO, Gurayah T. Burden of disability in type 2 diabetes mellitus and the moderating effects of physical activity. World J Clin Cases. 2023;11(14):3128–39. DOI: 10.12998/wjcc.v11.i14.3128; PMCID: PMC10237122; PMID: 37274052
Courtenay M, Carrier J, Bodman S. Medicines adherence in people with diabetes and disability, and the role of insulin delivery devices. J Diabetes Nurs. 2015;19(8):294–9.
Dassah E, Aldersey H, McColl MA, Davison C. Factors affecting access to primary healthcare services for persons with disabilities in rural areas: a “best-fit” framework synthesis. Glob Health Res Policy. 2018;3:36. DOI: 10.1186/s41256-018-0091-x
Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38(5):976–93. DOI: 10.1007/s10900-013-9681-1; PMCID; PMC4265215; PMID: 23543372
Yadav S, Sarangi A, Amor W, Nugent K. Psychosocial and Demographic Factors That Influence HbA1c Testing Frequency in Diabetics: Data From the 2018 Behavioral and Risk Factor Surveillance Survey (BRFSS). Cureus. 2022;14(9):e29798. DOI: 10.7759/cureus.29798; PMCID: PMC9618474; PMID: 36340524
Widayanti AW, Sigalingging KK, Dewi FP, Widyakusuma NN. Issues affecting medication-taking behavior of people with type 2 diabetes in indonesia: A qualitative study. Patient Prefer Adherence. 2021;15:989–98. DOI: 10.2147/ppa.s301501; PMCID: PMC8139640; PMID: 34040353
Nah EH, Cho S, Park H, Kim S, Kwon E, Cho HI. The usefulness of the estimated average glucose/fasting blood glucose ratio for pancreatic β-cell function assessment in hyperglycemia during health checkups. J Clin Lab Anal. 2022;36(10):e24693. DOI: 10.1002/jcla.24693; PMCID: PMC9550971; PMID: 36098986
DeWaters AL, Mejia D, Thomas J, Elwood B, Bowen ME. Patient Preparation for Outpatient Blood Work and the Impact of Surreptitious Fasting on Diagnoses of Diabetes and Prediabetes. Mayo Clin Proc Innov Qual Outcomes. 2020;4(4):349–56. DOI: 10.1016/j.mayocpiqo.2020.04.002; PMCID: PMC7411170; PMID: 32793862
Ong WM, Chua SS, Ng CJ. Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: A qualitative study. Patient Prefer Adherence. 2014;8:237–46. DOI: 10.2147/ppa.s57567; PMCID: PMC3931581; PMID: 24627628
Brundisini F, Vanstone M, Hulan D, DeJean D, Giacomini M. Type 2 diabetes patients’ and providers’ differing perspectives on medication nonadherence: A qualitative meta-synthesis. BMC Health Serv Res. 2015;15:516. DOI: 10.1186/s12913-015-1174-8; PMCID: PMC4657347; PMID: 26596271
Schabert J, Browne JL, Mosely K, Speight J. Social stigma in diabetes: A framework to understand a growing problem for an increasing epidemic. Patient. 2013;6(1):1–10. DOI: 10.1007/s40271-012-0001-0; PMID: 23322536
Bhattad PB, Pacifico L. Empowering Patients: Promoting Patient Education and Health Literacy. Cureus. 2022;14(7):e27336. DOI: 10.7759/cureus.27336; PMCID: PMC9411825; PMID: 36043002
Tang TS, Funnell MM, Noorulla S, Oh M, Brown MB. Sustaining short-term improvements over the long-term: Results from a 2-year diabetes self-management support (DSMS) intervention. Diabetes Res Clin Pract. 2012;95(1):85–92. DOI: 10.1016/j.diabres.2011.04.003; PMCID: PMC3783218; PMID: 21872962
Tang TS, Funnell M, Sinco B, Piatt G, Palmisano G, Spencer MS, et al. Comparative effectiveness of peer leaders and community health workers in diabetes selfmanagement support: Results of a randomized controlled trial. Diabetes Care. 2014;37(6):1525–34. DOI: 10.2337/dc13-2161; PMCID: PMC4030090; PMID: 24722495
Roberta L, Amoakoh-Coleman M, Djobalar B, Grobbee DE, Adjei GO, Klipstein-Grobusch K. Diabetes self-management education interventions and self-management in lowresource settings; a mixed methods study. PLoS One. 2023;18(7):e0286974. DOI: 10.1371/journal.pone.0286974; PMCID: PMC10348576; PMID: 37450431
Shaji S, Rajendran D, Kumpatla S, Viswanathan V. Evaluation of diabetes self-care with self-monitoring of blood glucose among type 2 diabetic patients and its impact on HbA1c. Int J Diabetes Dev Ctries. 2013;33(3):181–2. DOI: 10.1007/s13410-013-0118-2
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus. J Diabetes Metab Disord. 2013;12(1):14. DOI: 10.1186/2251-6581-12-14; PMCID: PMC3599009; PMID: 23497559
Schwandt A, Best F, Biester T, Grünerbel A, Kopp F, Krakow D, et al. Both the frequency of HbA1c testing and the frequency of self-monitoring of blood glucose predict metabolic control: A multicentre analysis of 15 199 adult type 1 diabetes patients from Germany and Austria. Diabetes Metab Res Rev. 2017;33(7):2908. DOI: 10.1002/dmrr.2908; PMID: 28544457
Lin M, Chen T, Fan G. Current status and influential factors associated with adherence to self-monitoring of blood glucose with type 2 diabetes mellitus patients in grassroots communities: a cross-sectional survey based on information-motivation-behavior skills model in China. Front Endocrinol. 2023;14:1111565. DOI: 10.3389/fendo.2023.1111565; PMCID: PMC10335788; PMID: 37441499
Downloads
Published
Issue
Section
Categories
License
Copyright (c) 2025 Agnes Christie Rinda, Umi Athiyah, Andi Hermansyah

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors continue to retain the copyright to the article if the article is published in the Borneo Journal of Pharmacy. They will also retain the publishing rights to the article without any restrictions.
Authors who publish in this journal agree to the following terms:
- Any article on the copyright is retained by the author(s).
- The author grants the journal the right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share work with an acknowledgment of the work authors and initial publications in this journal.
- Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of published articles (e.g., post-institutional repository) or publish them in a book, with acknowledgment of their initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their websites) prior to and during the submission process. This can lead to productive exchanges and earlier and greater citations of published work.
- The article and any associated published material are distributed under the Creative Commons Attribution-ShareAlike 4.0 International License.