Development and testing of the barriers to self-monitoring blood glucose scale.

Low levels of adherence to self-monitoring of blood glucose continue to occur despite its importance in the self-management of diabetes. Currently developed scales measure barriers to all components of diabetes regimen adherence but include only a few items about blood glucose testing. The purpose of this study was to develop the Barriers to Self-Monitoring Blood Glucose Scale and examine its psychometric properties. Data were drawn from two large diabetes clinics affiliated with large metropolitan hospitals. The 80-item scale examined the circumstance, thoughts, and feelings associated with barriers to testing blood glucose. Results suggest that individuals who test less often are more likely to report a higher number of barriers. This scale provides a means for assessing multiple barriers to testing that can provide the basis for healthcare practitioners to design individualized interventions to increase adherence to testing.

Lack of clinical significance of "enzyme-only" red cell alloantibodies.

In a retrospective study on samples from 10,000 recently transfused patients, 35 samples were found to contain an antibody that reacted with ficin-treated red cells but was not demonstrable by low-ionic-strength saline solution and indirect antiglobulin test (LISS-IAT). In those 35 patients, the specificity of the antibody was such that each patient would have been transfused with antigen-negative blood had the antibody reacted in LISS-IAT. Tests on red cells from the units already transfused showed that 19 patients had among them received, by chance, 32 antigen-positive and 74 antigen-negative units. The remaining 16 patients had among them received 57 units that were, again by chance, all antigen negative. One patient given antigen-positive blood suffered a delayed transfusion reaction; in two others the antibodies became LISS-IAT active after transfusion. However, similar changes to the LISS-IAT-active state were seen with two antibodies of patients given only antigen-negative blood. Also found in the 10,000 patients were 28 clinically insignificant antibodies, 77 sera in which the antibody was too weak to identify, and 216 autoantibodies that reacted only with ficin-treated red cells. These data support a belief, generally held in the United States but not necessarily elsewhere, that the use of protease-treated red cells for routine pretransfusion tests creates far more work than the accrued benefits justify.