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VOLUME 11 NUMBER 4 • NOVEMBER 2014
LEARNING FROM PRACTICE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
prick method and did not assess which specific device was used.
Most modern glucometers have the manufacturer’s own finger-
prick device where the lancet is inserted into a delivery barrel where
the needle is covered (see Fig. 1). While the authors acknowledge
that the pressure of release and the depth of the needle may
influence responses, this was not assessed. Additionally, details of
glycaemic control and any relationship with anxiety scores were not
evaluated in this study.
Statisticalmethods usedwereKendall’s tau_b for rank correlations
to investigate associations between anxiety to the finger prick, with
continuous variables such as general anxiety, age, disease duration,
type of treatment, amount of testing, and avoidance of testing.
A chi-square test was carried out to evaluate whether FPA and
general anxiety differed across categorical variables of gender and
ethnic groups.
Ethical approval was obtained from Riverside Research Ethics
Committee.
Results
From 350 outpatients invited to participate in the study, 315
completed the questionnaire (response rate of 90%). The study
group, with 58% male subjects, had a mean age of 47 (range
19–86) years. Ethnic groups comprised Caucasian (74%), Asian
or Asian British (11%), black or black British (7%), mixed (5%),
othernot specified (3%). Treatments used were either insulin alone
or in combination with oral glucose-lowering agents (54%), oral
glucose-lowering agents alone (40%), or with diet alone (6%).
Self-reported glucose monitoring
From the study sample, 93% reported that they performed rou-
tine self blood glucose monitoring, with 50% testing at least twice
per day, 23% testing once per day, 20% testing at least twice per
week, and only 7% testing once per week or less.
Finger-prick anxiety
FPA (Table 1) was observed in 30% of patients; more women (38%)
than men (24%) reported FPA (x² (1) = 6.352, p < 0.01); the black
group had a significantly higher proportion of FPA compared to
other ethnic groups (x² (4) = 17.680,
p
< 0.01). There was no
significant effect of age.
General anxiety
General anxiety (Table 1) was observed in 33% of the group; anxiety
was highest in the mixed ethnic group (43%) and women (46%);
and in the 31- to 40-year age group. In the older age group (71+)
there was less general anxiety (14%).
Significant negative correlations were found between age and
general anxiety (Kendall’s tau_b –0.119,
n
= 292,
p
< with younger
adults reporting increased general anxiety, and general anxiety was
more prevalent in women (x² (1) = 13.041,
p
< 0.01). There were
no differences between the different ethnic groups.
Avoidance by patients of finger-prick blood glucose testing
Avoidance of testing was significantly correlated with FPA (Kendall’s
tau_b 0.179, n = 311, p < 0.001) as well as FPA with general anxiety
(Kendall’s tau_b 0.225,
n
= 299,
p
< 0.001), demonstrating that
those who avoided self-monitoring had higher levels of FPA and
higher levels of general anxiety.
In response to the additional specific question of avoidance
of monitoring due to FPA, 13.7% of the total group and 19% of
those who did not routinely monitor their blood glucose answered
yes. Avoidance was higher in the non-defined (‘other’) ethnic
group (Table 2) and was statistically significant (x² (8) = 27.104,
p
<
0.001); however, age and gender were not.
Several reasons for avoidance of glucose testing were given
(Table 3). While only one in five of this total group had specific
anxiety to the finger-prick method, other reasons for reduced
Table 1.
Prevalence of anxiety to the finger-prick method of blood glucose testing (finger-prick anxiety) and general anxiety according to gender,
ethnicity, and age in individuals with diabetes (
n
= 315).
Whole group Gender Ethnicity Age groups (years)
Finger-prick anxiety
95 (30%)
Women 51 (38%)
Black 14 (62%)
18–30 9 (26%)
(defined as an FPA score >3)
Men 44 (24%)
Other 5 (50%)
31–40 13 (26%)
Asian 14 (42%)
41–50 16 (29%)
Mixed 5 (36%)
51–60 23 (36%)
Caucasian 57 (25%)
61–70 22 (34%)
71+ 12 (24%)
General anxiety
104 (33%)
Women 56 (46%)
Mixed 6 (43%)
18–30 9 (29%)
(defined as a GAS score > 8)
Men 44 (25%)
Asian 12 (40%)
31–40 22 (43%)
Caucasian 77 (34%)
41–50 19 (38%)
Black 6 (33%)
51–60 23 (37%)
Other 3 (30%)
61–70 24 (39%)
71+ 7 (14%)
Figure 1.
Examples of lancing devices for finger-prick blood glucose testing.