Self-monitoring of blood glucose may improve control

Structured self-monitoring of blood glucose (SMBG) improves control and prompts more medication changes in patients with non-insulin-treated type 2 diabetes, a study found.

Researchers conducted a 12-month trial with 1,024 Italian patients with a median baseline hemoglobin A1c (HbA1c) of 7.3%, enrolled between May 2008 and May 2010.

After standardized education, 501 patients were randomized to intensive structured monitoring (ISM group), with fasting, preprandial, two hours postprandial, and postabsorptive measurements performed three days a week. Another 523 patients were randomized to active control (AC group), with the same four measurements performed at baseline and at six and 12 months. In the ISM group, the blood sugar logs were available to be reviewed by the clinicians at the routine clinic visits and thus gave the clinicians additional data on which to base medication and dietary adjustments. The blood sugar logs were not available to clinicians caring for the AC group. Results were published online June 4 by Diabetes Care.

Intent-to-treat analysis showed greater HbA1c reductions over 12 months in intensive structured monitoring patients than in active control patients, (−0.39% vs. −0.27%; between-group difference, −0.12%; 95% CI, −0.210% to −0.024%; P=0.013). In the per-protocol analysis, intensively monitoring patients also had even greater HbA1c reduction than active control patients (−0.45% vs. −0.24%; between-group difference, −0.21%; 95% CI, −0.331% to −0.089%; P=0.0007). More intensive patients achieved clinically meaningful reductions in HbA1c (>0.3%) than did active control patients (P<0.025). Types and doses of diabetes medications were changed more often for intensive patients during visits two, three and four, but by visit five, the between-group difference did not achieve statistical significance.

Study authors attributed the success in reducing HbA1c in the intensive group to multiple factors. The data may have prompted clinicians to adjust therapy earlier and more intensely. The intensive group also had a greater decrease in body mass index (although it was not statistically significant), which may have contributed to improving glycemic control, and this group may have made more effective lifestyle changes in response to their measurements.

Although both groups reported similar diabetes-specific quality-of-life scores, the study was limited by a number of patients (200 of 501) who did not complete the intensive self-monitoring as assigned, suggesting that the regimen may have been too intensive, study authors acknowledged. “It is possible that less frequent use of the glycemic profiles (e.g., a lower number of weekly profiles) would encourage more patients to use structured SMBG but without sacrificing the beneficial effects seen in our study,” the authors wrote. “Additional studies are needed to further define and elucidate the optimal implementation of structured SMBG use in these patients.”