Structured self-monitoring of blood glucose reduces glycated hemoglobin in insulin-treated diabetes

Abstract

The aim of the preset study was to investigate the effectiveness of structured self-monitoring of blood glucose (SMBG) in insufficiently controlled insulin-treated diabetes. A total of 86 insulin-treated patients were randomized to a routine testing group (RTG; n = 43) and a structured testing group (STG; n = 43). The STG used a chart to record seven-point blood glucose (BG) profile on three consecutive days per month. The primary end-point was the glycated hemoglobin (HbA1c) at 3 months and 6 months. There were no significant differences of HbA1c between the RTG and STG at 3 months. However, the STG had significantly improved HbA1c at 6-month follow-up compared with the RTG (P = 0.002). In the STG, HbA1c decreased by 0.5% from 7.9 (SD 0.5) to 7.4 (0.7)%, whereas it decreased by 0.1% in the RTG from 7.9 (0.5) to 7.8 (0.7)%. In the STG, 55% of the patients were willing to continue structured SMBG and they achieved a 0.7% decrease of HbA1c. The present findings suggest that structured SMBG significantly improves glycemic control.

Keywords: Glycemic control; Insulin‐treated diabetes; Self‐monitoring of blood glucose.

Figure 1

Consort diagram of the patients. A total of 86 insulin‐treated patients were randomized to the structured testing group (STG) or routine testing group (RTG), with two and one drop‐outs during the 3‐month study, respectively. A total of 41 patients in the RTG and 42 in the STG completed the 3‐month study and follow‐up until 6 months. In the STG, 19 returned to routine self‐monitoring of blood glucose (SMBG) and 23 continued structured testing with the Accu‐Chek^®360° View Blood Glucose Analysis System during follow up until 6 months. QOL, quality of life; STG1, a subgroup of the STG that continued the seven‐point 3‐day testing and recorded data with the Accu‐Chek^®360° View Blood Glucose Analysis System; STG2, a subgroup that went back to routine testing and logbook recording.

Figure 2

Changes of glycated hemoglobin HbA1c over time. The structured testing group (STG) showed improved glycemic control compared with the routine testing group (RTG), with the difference of HbA1c being 0.4%. A subgroup of the STG that continued the seven‐point 3‐day testing and recorded data with the Accu‐Chek^®360° View Blood Glucose Analysis System (STG1) continued structured testing until 6 months and improved further, with the difference of HbA1c being 0.6%. Both differences were statistically significant.