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VOLUME 11 NUMBER 4 • NOVEMBER 2014
163
SA JOURNAL OF DIABETES & VASCULAR DISEASE
LEARNING FROM PRACTICE
Anxiety associated with self-monitoring of capillary blood
glucose
AMY SHLOMOWITZ, MICHAEL D FEHER
Correspondence to: Amy Shlomowitz
Thomas Addison Unit, St Georges Healthcare NHS Trust, London, and Beta
Cell Diabetes Centre, Chelsea and Westminster Hospital, London, UK
Tel: +44 (0)20 8266 6618
e-mail:
amyshlom@hotmail.comMichael D Feher
Beta Cell Diabetes Centre, Chelsea and Westminster Hospital, London,
Diabetes Therapy Evaluation Network, London, and CSRI, Warwick Univer-
sity, Warwick, UK
Previously published in
Br J Diabetes Vasc Dis
2014;
14
: 60–63
S Afr J Diabetes Vasc Dis
2014;
11
: 163–166
Abstract
Aims:
The aims were to evaluate (1) prevalence and con-
tributing factors of anxiety to the finger-prick method used
to self-monitor glucose; (2) whether individuals report
avoidance of self-monitoring due to fear of the finger-prick
method; and (3) levels of general anxiety.
Methods:
Individuals attending a specialist diabetes out-
patient centre, and who self-monitored their capillary
blood glucose concentrations, were invited to complete a
standardised questionnaire to assess anxiety associated with
the finger-prick method of blood glucose measurement, and
general day-to-day anxiety.
Results:
From 315 (58% male) individuals with diabetes,
finger-prick anxiety was observed in 30% and general anx-
iety in 33%. Positive correlations were found for finger-prick
anxiety with avoidance of testing and with general anxiety.
Older individuals had less general anxiety and females
reported greater anxiety to the finger-prick method and
general anxiety. There were ethnic differences in anxiety to
the finger-prick method and avoidance of testing, but not to
general anxiety.
Conclusions:
One-third of a general diabetes out-patient
cohort had general anxiety and anxiety to the finger-prick
method for glucose testing. There are important implications
for both patients and healthcare professionals in identifying
barriers to achieving improved diabetes control.
Keywords:
finger-prick anxiety, anxiety, diabetes, glucose testing,
lancet
Introduction
Self-monitoring of blood glucose is routine practice for many
individuals with diabetes. This requires a drop of capillary blood
to be obtained by pricking the tip of a finger with a modified
lancet.
1
To date there is limited evidence evaluating anxiety to the
finger-prick method, in contrast to several studies assessing anxiety
and phobia to self-injection with needles used for subcutaneous
insulin.
2
This is set in a background for a diabetes group, where
simple phobias and general anxiety are twice as common compared
to the general population.
3
Anxiety has also been linked to worse
glycaemic control.
4
The aims of the current study were to evaluate in a diabetes
cohort (1) the prevalence and contributing factors of anxiety to
the finger-prick method used to monitor blood glucose concen-
trations; (2) whether individuals avoid self-monitoring due to fear
of the finger-prick method; and (3) levels of general anxiety.
Patients and methods
The study design was a cross-sectional questionnaire survey.
Recruitment over a four-month period included individuals with
either type 1 or type 2 diabetes who attended for routine out-patient
follow up at the specialist Beta Cell Diabetes Centre of the Chelsea
and Westminster Hospital Foundation Trust, London. Unselected
patients who consented completed a written questionnaire , which
assessed demographic and treatment details, aspects of anxiety
to the finger-prick method to measure glucose levels, and levels of
general anxiety.
General anxiety was measured using the well-known Anxiety
subscale of the Hospital Anxiety and Depression Scale (HADS).
2
Anxiety to the finger-prick method, defined as finger-prick anxiety
(FPA), was assessed using the previously published injection
anxiety measure
2
with the questions being tailored to focus on
the finger-prick method rather than the needle injection used to
administer insulin (Appendix 1 available online at
www.bjdvd.
com). Components tested were attitudes to self-monitoring of
blood glucose and subjective current physical and psychological
responses prior to and at the time of testing. Participants were given
a score according to responses (score categories: unconcerned = 0,
concerned = 1, mild/moderate and fear = 3) when they actually
tested their blood glucose. An affirmative answer to the question
about physical symptoms prior to monitoring, received one point
for each symptom with a maximum possible score of four points.
The other four questions scored one point for an affirmative
answer. For the whole test, the minimum total score obtainable
was 0 with a maximum total score of 14. A total score of ≥ 3 was
used to classify those as having at least some anxiety to the finger-
prick method.
2
An additional assessment was made to gain further
details on reasons why an individual might avoid the finger-prick
method of glucose monitoring. The questions asked were: ‘do you
test less than recommended or not test at all due to dislike/fear of
needles or other reasons?’ Participants could answer ‘yes’, ‘no’, or
state other reasons.
To explore general psychological factors further, general anxiety
was assessed by the anxiety subscale of the hospital anxiety and
depression score (HADS)5 (Appendix 2 available online at www.
bjdvd.com). A general anxiety score (GAS) of > 8 (the minimum
score being 0 and maximum 21) was used as the threshold to
identify anxiety according to previous published studies.
6
The study evaluated responses of those undertaking the finger-