Structured self-monitored blood glucose with pattern analysis has been associated with greater reductions in A1c. It also requires less testing than the standard approach, and promotes more timely and aggressive treatment changes in poorly controlled, non-insulin-treated patients with Type 2 diabetes, according to study results….
Lead author Pamela Kushner, MD, Long Beach, California, stated that, the 12-month, randomized, controlled, multicentre study assessed the effect of structured testing on results of HbA1c.
In all, 483 insulin-naïve subjects were selected based on their poorly controlled (HbA1c >= 7.5%) Type 2 diabetes. The patients were randomized into 2 divisions: usual care in the Active Control Group or usual care with a minimum quarterly use of structured testing with pattern analysis in the Structured Testing Group. All patients were instructed to monitor their blood glucose as usual, based on their healthcare providers’ instructions, but Structured Testing Group members were also instructed on recording blood glucose levels, food eaten, and energy levels as well as pattern analysis. Patients in the Structured Testing Group had to complete a 3-day structured testing session, involving 7 tests per day, prior to quarterly visits, and all patients were seen at least once quarterly as well as performing self-monitored blood glucose between study visits.
Both groups did have significant reductions in HbA1c over the trial period, but an intent-to-treat analysis showed greater reductions in the Structured Testing Group than in the Active Control Group (-1.2% vs. -0.9%, P =.04). Furthermore, mean daily blood glucose tests were significantly lower for the Structured Testing Group than the Active Control Group at 6, 9, and 12 months (P =.007,.001, and.0004, respectively), reported Dr. Kushner.
Structured Testing Group healthcare providers were 31% more likely to recommend at least 1 medical treatment change at the first treatment visit 1 month post baseline, 33% were more likely to recommend lifestyle adjustments, and 33% were more likely to recommend a combination of the two (P =.0001). Subjects who received this treatment change at the first visit were able to achieve a significantly larger HbA1c reduction than those who did not receive a recommendation. “And they were significantly less likely to have clinical inertia,” Dr. Kushner added.
Ultimately, the researchers concluded that “early treatment changes are linked to significant glycemic improvement over 12 months, and may be a major reason why subjects in the Structured Testing Group evidenced a significantly greater reduction in HbA1c than Active Control Group subjects.” Dr. Kushner also noted that patients and physicians reported that they “liked having the ability to track patterns in their results based on their behavior.”
For a copy of the form used by the patients for the pattern analysis see our Tool for Your Practice, 360 View — A Simple Blood Glucose Analysis System (PDF).
[Structured Blood Glucose Testing Leads to Improvements in HbA1c in Patients With Poorly Controlled, Non-Insulin-Treated Type 2 Diabetes. Results from the Structured Testing Program (STeP) Study. Abstract P058]