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Outcomes of Self-monitoring of Blood Glucose in Type 2 Diabetes

Effect of frequent, self-monitoring of blood glucose may not be significant…. 

In this randomized controlled trial, researchers assessed whether self-monitoring of blood glucose (SMBG) results in better glycemic control. At study centers led by members of the German Diabetes Association, participants were randomized in a prospective, open, 2 by 2 factorial designed study. Participants were type 2 diabetes patients using conventional insulin regimens (defined as basal or premixed insulin with or without additional oral glucose-lowering agents). Researchers compared self-monitoring of blood glucose (SMBG+) with non-self-monitoring of blood glucose (SMBG–) the measurement and transmission of HbA1c results to the study centers (HbA1c+) along with HbA1c measurement in which results were not disclosed (HbA1c–). Patient characteristics were similar among groups.

The primary endpoint of this study was the reduction in HbA1c from baseline at 12 months. Secondary outcomes included insulin therapy intensification in response to higher blood glucose levels (determined by elevated Hb1Ac or elevated urinary glucose).

No reductions between groups were found (0.0%, −0.2%, 0.2%, p = 0.93). In the SMBG+ group, HbA1c was reduced by 0.3% (0.1%, 0.5%) compared to SMBG– group 0.3% (0.2%, 0.5%). The disclosure of HbA1c results had no significant influence on the overall outcomes, with a difference of 0.1% (CI 95%, −0.1% to 0.4%, P = 0.28). In addition, researchers observed a significant increase in the ORs for therapy intensification in regards to the following: increased urine samples positive for glucose, increased HbA1c, and increased fasting or postprandial glucose concentrations. No significant adverse events were associated with the study interventions.

Practice Pearls:
  • The effect of self-monitoring of blood glucose may or may not be beneficial depending on the particular patient; however, indicators of hyperglycemia may result in therapy intensification
  • Intensification of insulin therapy may be necessary for a greater impact on glycemic control
  • Greater glycemic control is associated with better microvascular and macrovascular outcomes

Nauck MA, Haastert B, Trautner C, et al. A randomised, controlled trial of self-monitoring of blood glucose in patients with type 2 diabetes receiving conventional insulin treatment. Diabetologia. 2014;57(5):868-77. http://link.springer.com/article/10.1007/s00125-014-3168-1