Longitudinal Study of New and Prevalent Use of Self-Monitoring of Blood Glucose

Kaiser Permanente, Oakland, California, United States
Diabetes Care (Impact Factor: 8.42). 08/2006; 29(8):1757-63. DOI: 10.2337/dc06-2073
Source: PubMed


We sought to assess longitudinal association between self-monitoring of blood glucose (SMBG) and glycemic control in diabetic patients from an integrated health plan (Kaiser Permanente Northern California).
Longitudinal analyses of glycemic control among 1) 16,091 patients initiating SMBG (new-user cohort) and 2) 15,347 ongoing users of SMBG (prevalent-user cohort). SMBG frequency was based on pharmacy use (number of blood glucose test strips dispensed), and glycemic control was based on HbA(1c) (A1C). In the new-user cohort, ANCOVA models (pre- and posttest design) were used to assess the effect of initiating SMBG. In the prevalent-user cohort, repeated-measure, mixed-effects models with random-intercept and time-dependent covariates were used to assess changes in SMBG and A1C. All models were stratified by therapy (no medications, oral agents only, or insulin) and adjusted for baseline A1C, sociodemographics, insulin injection frequency, comorbidity index, medication adherence, smoking status, health care use, and provider specialty.
Greater SMBG practice frequency among new users was associated with a graded decrease in A1C (relative to nonusers) regardless of diabetes therapy (P < 0.0001). Changes in SMBG frequency among prevalent users were associated with an inverse graded change in A1C only among pharmacologically treated patients (P < 0.0001).
These observational findings are consistent with short-term benefits of initiating SMBG practice for all patients but continuing benefits only for pharmacologically treated patients. Differences in effectiveness between new versus prevalent users of SMBG have implications for guideline development and interpretation of observational outcomes data.

Download full-text


Available from: Howard H Moffet
  • Source
    • "Whereas some guidelines are moving away from recommending SMBG use in patients not treated with insulin, this study, and that of Karter,13 may indicate that SMBG use in some subgroups of non-insulin-using patients is beneficial, at least initially, as a means of allowing a patient to understand his or her condition and the impact of behaviors upon it. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the impact of self-monitoring blood glucose (SMBG) strip use in patients with type 2 diabetes in the UK. The study period was April 1, 2004 to July 31, 2005. Data from primary care was extracted from The Health Improvement Network database. Patients identified with diabetes and matching the inclusion criteria were defined as new users of SMBG, prevalent users, or non-users. Patients were also defined as treated with insulin, with oral agents (OA), or not pharmacologically treated. Change in glycosylated hemoglobin (HbA(1c)) at baseline and after 12 months was compared. 2559 patients met the inclusion criteria. For new users, HbA(1c) fell by 0.59% (P=0.399) for those treated with insulin, 1.52% (P<0.001) for those treated with OA, and 0.51% (P<0.001) for no treatment. In prevalent users, changes were 0.31% (P<0.001), 0.34% (P<0.001), and 0.09% (P=0.456), respectively. In non-users, changes were 0.28% (P=0.618), 0.42% (P<0.001), and an increase of 0.05% (P=0.043), respectively. A significant decrease in mean HbA(1c) was associated with increasing strip use in OA patients newly initiated on strips. This observational study showed a significant decrease in HbA(1c) for new users of SMBG treated either non-pharmacologically or with OA, and for prevalent users treated with insulin or OA. Reduced HbA(1c) with increasing strip use was observed but was only significant for OA-treated new users. This suggests that SMBG use has a role in the treatment of non-insulin treated patients with type 2 diabetes.
    Full-text · Article · Aug 2010 · Diabetes Therapy
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background. Modern management of diabetes mellitus, which enables patients to avoid disability, requires full glycaemic control. Achievement of normal glucose levels is only possible with the help of self-monitoring of blood glucose (SMBG) and adjusting the treatment depending on the measured values. The aim of the study was to assess the way in which glucose meters are used based on the evaluation of test strip coding, diet adjustments and dosage of medications depending on the measured blood glucose values. Material and methods. A total of 510 consecutive patients (including 99 patients with type 1 diabetes mellitus) managed at the Provincial Diabetes Clinic in Zabrze, Poland, were included in the study. The mean age was 60 ± 19 years, duration of diabetes was 12 ± ± 9 years and the mean body mass index was 29.1 ± ± 5.63 kg/m 2 (24.4 ± 4.3 kg/m 2 and 30.2 ± 4.9 kg/m 2 in patients with type 1 and type 2 diabetes mellitus, respec- tively). The questionnaire contained general details and the patient's declarations regarding the glucose meter coding, self-monitoring and treatment adjustment. Data on glucose meter use were verified on the basis of the glucose meter evaluation (programmed dates and times as well as the numbers of measurements in the memory, correctness of the code). Results. Twenty-eight (5.4%) out of the 510 patients declared not having changed the code. Based on the glucose meter evaluation we found that 25 (4.9%) subjects had entered a wrong code (including 4 subjects who had not been informed) and 234 (63%) subjects had not programmed the date and time. Based on the evaluation of glucose levels 135 (27%) subjects declared no diet adjustment (85/355 (36%) of patients managed with insulin and 50/185 (39%) managed with oral antidiabetic drugs). Of the 326 patients managed with insulin 233 (72%) declared dosage adjustment with 58% declaring no more than two injections and 85% no more than 3 injections (P < 0.001). Conclusions. The recommendation to perform SMBG requires effective patient education on the technique of measurements, including the coding of glucose meters. A significant group of patients performing SMBG does not adjust their treatment despite abnormal glucose values. It seems that patient education on how to use the information obtained during SMBG may improve glycaemic control.
    No preview · Article ·
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To determine whether self monitoring, alone or with instruction in incorporating the results into self care, is more effective than usual care in improving glycaemic control in non-insulin treated patients with type 2 diabetes. Design Three arm, open, parallel group randomised trial. Setting 48 general practices in Oxfordshire and South Yorkshire. baseline to 12 months between the control and less intensive self monitoring groups was −0.14% (95% confidence interval −0.35% to 0.07%) and between the control and more intensive self monitoring groups was −0.17% (−0.37% to 0.03%). Conclusions Evidenceisnot convincingofan effectofself monitoring blood glucose, with or without instruction in incorporating findings into self care, in improving glycaemiccontrolcomparedwithusualcareinreasonably well controlled non-insulin treated patients with type 2 diabetes. Trial registration Current Controlled Trials ISRCTN47464659.
    No preview · Article ·
Show more