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Blood Glucose
Self-Monitoring Improves Metabolic Control in
Patients With Type 2 Diabetes
Self-monitoring of blood glucose (SMBG) is
associated with better quality of metabolic
control than conventional recommendations alone
in patients with type 2 diabetes mellitus
SMBG has been demonstrated to improve control of
blood glucose and long-term prognosis in
patients with type 1 diabetes. Theoretically,
SMBG in type 2 diabetes may improve compliance
with recommendations on diet, exercise, and
medication regimens.
However, SMBG increases patient management cost
and its efficacy in type 2 diabetes has not been
established. Bruno Guerci, MD, PhD, of Hopital
Jeanne d'Arc, Dommartin-les-Toul, France, and
colleagues performed a prospective study to
compare changes in metabolic control in patients
with type 2 diabetes managed with conventional
recommendations alone or combined with SMBG.
The patient population consisted of 988
diabetics, aged 40 to 75 years, with poor
response to oral antidiabetic treatment.
Patients were randomized to receive a
conventional laboratory work-up based solely on
measurement of hemoglobin (HbA1C)
every 12 weeks (group 1) or conventional
laboratory workup plus SMBG (group 2).
Group 2 patients received standardized training
for self monitoring procedures, and were
required to perform at least 6 capillary assays
a week. All patients were advised on diet and
exercise, and received follow up at 6-week
intervals over 24 weeks.
A total of 303 patients discontinued the study
(164 in group 2 and 139 in group 1). Analysis
showed that at endpoint, HbA1C was
lower in group 1 (8.1 ± 1.6%) than in group 2
(8.4 ± 1.4%, P = .012).
After 3 months, 57.1% of patients in group 2
versus 46.8% in group 1 had an improvement
(change > .5%) in HbA1C level (P
= .007). Factors predictive of improvement in
HbA1C levels included HbA1C
at baseline: odd ratio (OR) = 1.749 (P
< .001), SMBG group (reference value: group
2): OR = .665 (P = .015), duration of
diabetes: OR = .953 (P = .001), and body
mass index: OR = .962 (P = .039).
Furthermore, compliance to dietary instructions
remained stable in group 2 but decreased
significantly in group 1 (P = .045). No
statistical difference was found between groups
for the intensity of usual physical activity.
"This is the first study on a large number
of patients and designed to analyze the
influence of self monitoring of blood glucose on
metabolic control in type 2 diabetes, according
to dietary, lifestyle and drug regimen
recommendations," Dr. Guerci and colleagues
note. "This approach has proven to be
acceptable and feasible, and its objective was
to achieve care of type 2 diabetic patients as
close as possible to their own home
environment." Diabetes Metab 2003
Dec;29:6:587-94
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