Intensified Blood Glucose Monitoring Improves Glycemic Control in Stable, Insulin-Treated Veterans With Type 2 Diabetes

Abstract

OBJECTIVE -To examine the effect of intensified self-monitored blood glucose (SMBG) testing on glycemic control. RESEARCH DESIGN AND METHODS-Subjects with stable, insulin-treated type 2 diabetes performed SMBG using an electronic blood glucose meter before all meals and at bedtime for 8 weeks. Baseline data were collected on demographics, clinical characteristics, diet, and exercise. HbA 1c was measured at baseline, at 4 weeks, and at 8 weeks. After the intensified monitoring period, subjects resumed their usual monitoring. HbA 1c was then measured at 24, 37, and 52 weeks. Multivariate linear regression was used to determine the effect of monitoring on glycemic control.RESULTS -A total of 201 subjects completed the monitoring period. The baseline HbA 1c (8.10 Ϯ 1.67%) decreased during the monitoring period by 0.30 Ϯ 0.68% (P Ͻ 0.001) at 4 weeks and by 0.36 Ϯ 0.88% (P Ͻ 0.001) at 8 weeks. Although entry HbA 1c and compliance independently predicted the week 8 HbA 1c (r ϭ 0.862, P Ͻ 0.001), standardized regression analysis found that compliance with the SMBG protocol influenced the week 8 HbA 1c more than age, sex, BMI, exercise level, carbohydrate consumption, or treatment intensity at baseline. However, SMBG benefited only subjects whose testing compliance exceeded 75% or with an entry HbA 1c Ͼ8.0%. Decreases in HbA 1c (Ϫ0.31 Ϯ 1.17%, P ϭ 0.001) persisted in the 159 subjects followed for 52 weeks.CONCLUSIONS -Intensified blood glucose monitoring improved glycemic control in a large cohort of stable, insulin-treated veterans with type 2 diabetes. SMBG provided a strong stimulus for improved self-care resulting in clinically important and sustained reductions in HbA 1c .

Self-Monitoring of Blood Glucose in Diabetes: From Evidence to Clinical Reality in Central and Eastern Europe—Recommendations from the International Central-Eastern European Expert Group

“…32 Like in type 1 diabetes, the rationale for the use of SMBG in insulin-treated type 2 diabetes is compelling and is supported by data from large prospective and observational trials. 30,33,34 Similar to the Diabetes Control and Complications Trial, the Kumamoto study showed that intensive insulin therapy guided by SMBG can reduce the risk of microvascular complications compared with conventional therapy in type 2 diabetes. 33 In the Diabetes Outcomes in Veterans Study (DOVES), intensified SMBG improved glycemic control (0.3% reduction in HbA1c over 1 year) in a large cohort of stable, insulin-treated veterans with type 2 diabetes.…”

“…33 In the Diabetes Outcomes in Veterans Study (DOVES), intensified SMBG improved glycemic control (0.3% reduction in HbA1c over 1 year) in a large cohort of stable, insulin-treated veterans with type 2 diabetes. 34 Benefits were only seen in patients whose SMBG compliance exceeded 75% or those with baseline HbA1c > 8% (64 mmol/mol).…”

Blood glucose monitoring in type 2 diabetes – Nepalese patients’ opinions and experiences

“…While regular self-monitoring of blood glucose (SMBG) levels using glucometers is regarded as an essential tool for self-care [2,9–11], tests performed in accredited laboratories are preferred for confirming diagnoses, and are used in clinical and therapeutic decision making [2]. …”

An international, multicenter, observational survey to evaluate diabetes control in subjects using insulin for the treatment of type 1 and type 2 diabetes mellitus in the Czech Republic and Slovak Republic: study protocol for a cross-sectional survey

“…Since the price of the test strips decreased to almost one half compared to that in the year 2007 and there were also changes in the reimbursement of the strips from the public health insurance schemes (to a certain extent, the strips are also reimbursed to patients with less than three daily administrations of insulin), an increase in the frequency of blood glucose self-monitoring can be expected, which can have a positive effect on glycemic control in the groups of patients being monitored. [16][17][18] In addition to physiological and pathophysiological factors (higher body mass index, longer duration of diabetes, younger age, which are associated with higher HbA1c levels in patients with type 2 diabetes), 19 the internal factors influencing the glycemic control also include a group of factors that could be called skills and are related mainly to insulin therapy. These factors include, in particular, adherence to dietary recommendations and restrictions, conditions associated with hypoglycemic episodes (see later), the frequency and use of self-monitoring, adherence to insulin therapy, and sufficient physical activity.…”