Glycemic impact of intensified self monitoring of blood glucose in insulin treated subjects with type 2 diabetes mellitus

Abstract

Objective:The aim of this study was to evaluate if intensified self-monitoring of blood glucose (SMBG) improves glycemic control in insulin-treated subjects with type 2 diabetes mellitus (T2DM). Methods:Ninety-six adults with stable but poorly controlled [glycated hemoglobin (HbA1c) level >7.5%] T2DM receiving twice-daily biphasic insulin were randomly assigned to either of the two groups: intensive monitors (IM) that performed SMBG at least twice daily or conventional monitors (CM) that performed SMBG at their discretionary frequency for 12 weeks. Demographic, clinical, and glycemic indices, including fasting blood glucose (FBG), postprandial glucose (PPG), and HbA1c, were compared at baseline and week 12. Results:A total of 71 subjects (25 IM and 46 CM) completed the study. Both groups had similar HbA1c at baseline. From baseline to week 12, the IM group had higher mean daily test strip usage (P <0.001), engaged in more frequent insulin dose adjustments (P <0.001), and attained greater daily insulin dosage (P = 0.002). All glycemic indices including FBG, PPG, and HbA1c improved significantly from baseline to week 12 in the IM but not in the CM group. HbA1c level declined by −1.2 ±0.4% in the IM group (P = 0.002). There was no difference in the frequency of hypoglycemia in both groups. The monthly cost of intensified SMBG was nearly four times that of conventional monitoring (P <0.001). Conclusion:Both short- and long-term glycemic control significantly improved by intensified SMBG in stable but poorly controlled insulin-treated adults with T2DM. Intensified SMBG enabled better self-titration of insulin and probably other self-care practices. This benefit, however, occurred at the expense of costs that may be difficult to sustain in resource-poor countries.

The Nursing Implementation of Monitoring Blood Glucose in Increasing the Stability of Blood Glucose Level in Patients with Diabetes Mellitus

“…This will greatly help patients to be able to find out their blood glucose levels at any time so that patients know the fluctuations in blood glucose levels, including when hypoglycemic complications arise early [15]. This is in line with [16] case study research entitled Family Nursing Care with Diabetes Mellitus in the Work Area Of the Sempaja Puskesmas ,Samarinda) " which carried out the implementation of blood sugar monitoring and health education for 5 days of implementation and succeeded in knowing the occurrence of hypoglycemia (GDS: 60 mg / dL) on the fourth day and blood glucose levels stabilized on the fifth and sixth days, namely 159 mg / dL and 151 mg / Dl [16]. In addition, the nursing care conducted by [12] entitled Efforts to Increase Family Knowledge to Prevent the Risk of Hypoglycemia in Mr.S in Gatak Village [11] shows that before implementation, Mr. S. was tired of taking medication and neglecting his diet, the family also did not pay attention his diet, and rarely check his blood glucose level.…”