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

Abstract

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.

American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

“…As shown in Table 1, studies of BGM in T2DM have presented mixed conclusions. Several have shown a clear benefit from frequent BGM (11,12,(28)(29)(30). This has been particularly evident for patients with T2DM who are receiving insulin therapy, especially involving multiple daily injections (MDI), "basal-bolus" therapy, or insulin pump (continuous subcutaneous insulin infusion) (31).…”

“…Both capillary blood glucose monitoring (BGM) and continuous glucose monitoring (CGM) with interstitial fluid sensors enable patients to better understand the impact of diet, exercise, illness, stress, and medications on glucose levels and to recognize and treat hypoglycemic and hyperglycemic episodes. Likewise, both BGM and CGM have been shown to improve the efficacy and safety of diabetes therapy (3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

Optimal glucose control in type 2 diabetes mellitus—a guide for the family practitioner

“…11 It demonstrated that morbidity and mortality were significantly lower in patients doing SMBG (adjusted hazard ratios 0.68 and 0.49 respectively). In other words morbidity and mortality was respectively 32% and 51% lower in patients who do SMBG.…”

Benefits of Three-Month Continuous Glucose Monitoring for Persons With Diabetes Using Insulin Pumps and Sensors

“…The emergence of test strips and glucometers in the last 30 years has enabled the glucose concentration self-monitoring and this has gradually replaced the relatively inaccurate and inconvenient measurement of glucose in urine [3][4][5][6][7][8][9][10][11][12][13] . A large amount of attention is given to the frequency of self-monitoring and its effectiveness [14][15][16] . In 1993, the well known study DCCT (Diabetes Control and Complications Trial) emphasized that in PWD1 SMPG should be performed at least four times daily and subsequently corrected with intensive insulin therapy 17,18 .…”