Effects of Health Maintenance Organization Coverage of Self-monitoring Devices on Diabetes Self-care and Glycemic Control

Soumerai, Stephen B.; Mah, Connie; Zhang, Fang; Adams, Alyce S.; Barton, Mary B.; Fajtova, Vera; Ross‐Degnan, Dennis

doi:10.1001/archinte.164.6.645

Cited by 63 publications

(60 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In these patients, an SMBG frequency of at least once per day was related to significantly higher levels of distress and worries. In other studies, increased use of SMBG has been shown to be associated with improved medication compliance [8,26]. We found that patients in the SMBG group visited the treating physician more frequently.…”

Section: Hr (95% Ci)supporting

confidence: 54%

Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study

et al. 2005

View full text Add to dashboard Cite

Aims/hypothesis: The aim of this study was to obtain epidemiological data on self-monitoring of blood glucose (SMBG) in type 2 diabetes and to investigate the relationship of SMBG with disease-related morbidity and mortality. Methods: The German multicentre Retrolective Study 'Self-monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes' (ROSSO) followed 3,268 patients from diagnosis of type 2 diabetes between 1995 and 1999 until the end of 2003. Endpoints were diabetesrelated morbidity (non-fatal myocardial infarction, stroke, foot amputation, blindness or haemodialysis) and all-cause mortality. SMBG was defined as self-measurement of blood glucose for at least 1 year. Results: During a mean followup period of 6.5 years, 1,479 patients (45.3%) began SMBG prior to an endpoint and an additional 64 patients started SMBG after a non-fatal endpoint. Interestingly, many patients used SMBG while being treated with diet or oral hypoglycaemic drugs (808 of 2,515, 32%). At baseline, the SMBG cohort had higher mean fasting blood glucose levels than the non-SMBG cohort (p<0.001), suggesting that insufficient metabolic control was one reason for initiating SMBG. This was associated with a higher rate of microvascular endpoints. However, the total rate of nonfatal events, micro-and macrovascular, was lower in the SMBG group than in the non-SMBG group (7.2 vs 10.4%, p=0.002). A similar difference was found for the rate of fatal events (2.7 vs 4.6%, p=0.004). Cox regression analysis identified SMBG as an independent predictor of morbidity and mortality, with adjusted hazard ratios of 0.68 (95% CI 0.51-0.91, p=0.009) and 0.49 (95% CI 0.31-0.78, p=0.003), respectively. A better outcome for both endpoints was also observed in the SMBG cohort when only those patients who were not receiving insulin were analysed. Conclusions/interpretation: SMBG was associated with decreased diabetes-related morbidity and all-cause mortality in type 2 diabetes, and this association remained in a subgroup of patients who were not receiving insulin therapy. SMBG may be associated with a healthier lifestyle and/or better disease management.

show abstract

Section: Hr (95% Ci)supporting

confidence: 54%

Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Similar findings were reported in other community-based studies [134,135]. In contrast, other studies found glycaemic deterioration with increased monitoring frequency among poorly controlled individuals with type 2 diabetes on insulin treatment [126,129].…”

Section: Factors To Effectiveness Of Smbgsupporting

confidence: 89%

“…Family support and self-efficacy were noted to increase testing frequency [124,125,135,141,142]. Cost is another significant predictor of less frequent monitoring [124,125,135,141,142]. Although Harris in 2001 found no association between socio-economic status and SMBG frequency, 90% of his subjects had health insurance [126].…”

Section: Confounders To Adherence To Smbgmentioning

confidence: 99%

See 1 more Smart Citation

Clinical critics in the management of diabetes mellitus

Gillani¹,

Sulaiman²,

Sundram³

et al. 2012

Health

View full text Add to dashboard Cite

There is a global epidemic of diabetes with its prevalence expected to increase from 5.1% in 2003 to 6.3% in 2025. This increase in diabetes is occurring in all nations, however, developing nations are particularly at risk. It spares no group and affects men, women, the elderly, young and people from very racial and socioeconomic background. Nevertheless, certain ethnic groups including Asians are affected more than Caucasians. Large randomized clinical trials have shown that improvement in glycaemic control, together with management of diabetes-related risk factors like blood pressure and lipid control significantly reduce the micro and macro complications in individuals with type 1 and type 2 diabetes. Patient education plays a crucial role in the prevention of diabetic fool problems. In Geneva, the rate of lower limb amputations was reduced by almost 75% after an educational intervention. People with diabetes must acquire the knowledge and skills through education to provide daily self-care in diabetes management which involves maintenance of healthy living, recognition and management of diabetes problems when they arise and taking preventive measures. Some factors include patients' biomedical variables, the psychosocial environment, the knowledge, attitudes and beliefs of patients themselves, home careers and health care providers, healthcare systems' accessibility and availability and even the national political context may influence these self-care behaviors.

show abstract

“…This reduced test strip use from 9.5 to 4.7 per week without significant change in glycemic control. In a second study (42), the intervention was provision of free blood glucose meters, which increased average SMBG in sulfonylureatreated patients from 0.5 to 2.0 tests per week without a significant A1C reduction in all but the worst-controlled patients. By contrast, in the only valid randomized controlled trial with sufficient power to detect a significant SMBG effect in OHAtreated patients (14), the required testing frequency was six times per week, which was associated with a reduction in A1C of 0.28%.…”

Section: Longitudinal Cohortmentioning

confidence: 99%

Is Self-Monitoring of Blood Glucose Appropriate for All Type 2 Diabetic Patients?

2006

View full text Add to dashboard Cite

OBJECTIVE -We sought to determine whether self-monitoring of blood glucose (SMBG) is associated with better glycemic control in type 2 diabetes.RESEARCH DESIGN AND METHODS -We used cross-sectional and longitudinal data from type 2 diabetic participants in the observational, community-based Fremantle Diabetes Study (FDS) who reported SMBG status at study entry (n ϭ 1,286) and annual reviews over 5 years (n ϭ 531).RESULTS -At study entry, 70% of patients performed SMBG, with a median of four tests per week (interquartile range two to seven). Patients with shorter diabetes duration; who were attending diabetes education, diabetes-related clinics, or medical specialists; who were taking insulin with or without oral hypoglycemic agents (OHAs); and who were self-reporting hypoglycemic events were more likely to use SMBG. Both cross-sectional and longitudinal FDS data showed that HbA 1c (A1C) was not significantly different between SMBG users and nonusers, either overall or within diabetes treatment groups (diet, OHAs, and insulin with or without OHAs). There was also no independent cross-sectional relationship between A1C and SMBG frequency. The average annual societal cost of using SMBG (in year 2000 Australian dollars [A$], excluding glucometers) was A$162 per type 2 diabetic patient or A$51 million when projected to the Australian diagnosed type 2 diabetic population.CONCLUSIONS -Neither SMBG testing nor its frequency was associated with glycemic benefit in type 2 diabetic patients regardless of treatment. Our data did not include methods of SMBG delivery and application, factors that require further assessment in the evaluation of SMBG utility in non-insulin-treated type 2 diabetes. SMBG may be still of value in the identification and prevention of hypoglycemia and in dose adjustment in insulin-treated patients. Diabetes Care 29:1764 -1770, 2006T here is strong evidence that intensive glycemic control cost-effectively reduces chronic, particularly microvascular, complications of type 2 diabetes (1,2). However, the role of selfmonitoring of blood glucose (SMBG) in type 2 diabetes management is less clear (3-5). As well as increasing the burden of self-care, SMBG contributes significantly to diabetes-attributable (6) and total (7) direct health care costs. There is a need for well-designed studies addressing the benefits and cost effectiveness of SMBG in community-based type 2 diabetes. This includes insulin-treated patients for whom SMBG is recommended without substantive supportive evidence (8 -10).Five randomized controlled trials have validly addressed the question of whether SMBG reduces A1C (11-15). Only one had sufficient statistical power to detect a 0.5% A1C difference between intervention and control groups (14), but SMBG was associated with a modest 0.3% A1C reduction in the OHA-treated, poorly controlled patients. Other nonrandomized controlled trial studies have had problems involving design, subject selection, definition of outcomes, and/or use of additional interventions, which question the validity a...

show abstract

Effects of Health Maintenance Organization Coverage of Self-monitoring Devices on Diabetes Self-care and Glycemic Control

Cited by 63 publications

References 33 publications

Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study

Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study

Clinical critics in the management of diabetes mellitus

Is Self-Monitoring of Blood Glucose Appropriate for All Type 2 Diabetic Patients?

Contact Info

Product

Resources

About