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Intensive Structured Self-Monitoring of Blood Glucose and Glycemic Control

Noninsulin-treated type 2 diabetes patients may benefit from intensive structured self-monitoring of blood glucose (SMBG)…. 

SMBG is recommended for patients with type 1 diabetes or those with type 2 diabetes who are treated with insulin in order to determine glycemic control. However, the usefulness of SMBG in type 2 diabetes patients who are noninsulin-treated has not been determined.

In a recent multicenter trial of more than 1,000 patients, patients who were not treated with insulin were randomized in a 1:1 ratio to either receive or not receive intensive structured monitoring. Both groups received medication treatment according to guidelines; however, those who were in the intensive structured monitoring group were required to perform and record 4-point glucose measures, which included measuring their glucose before breakfast and lunch, two hours after lunch and five hours after lunch but before dinner, three days a week for 12 months and provide these readings to their physician.

Each patient in both groups had physical examinations which recorded BMI, blood pressure, heart rate and HbA1c during follow-up visits at 3, 6, 9 and 12 months, and then were prescribed medications targeting an HbA1c < 7%. Additionally, those in the intensive structured monitoring group provided their SMBG readings to physicians, who made recommendations to change diet and physical activity, as well as altered the patient’s current medication regimen.

At the conclusion of the study, both groups of the intent-to-treat population had reductions in HbA1c, but those who were in the intensive structured monitoring group had a greater reduction versus the active group (-0.39% vs 0.27%, respectively). This may be attributable to the fact that the medication regimen was changed, and lifestyle changes were made, for the intensive structured monitoring patients more frequently based on their SMBG readings. The overall results, although there were some limitations, show that the use of an intensive structure of self-monitoring of blood glucose can improve glycemic control and provide guidance for physicians to prescribe medications for noninsulin-treated type 2 diabetes patients.

Practice Pearls:
  • Self-monitoring of blood glucose is recommended for those treated with insulin.
  • Intensive structured monitoring among noninsulin type 2 diabetes patient may improve glycemic control.
  • Four-point glucose measures were required in order to provide physicians with a better understanding of current therapy.

Diabetes Care, October 2013