Using a Blood Glucose Monitoring Manual to Improve Control

Use of a blood glucose (BG) monitoring manual improves glycemic control, according to the results of a randomized study.

"Frequent blood glucose (BG) monitoring is a critical component of diabetes management, yet many barriers exist to consistent monitoring," write C. Moreland, MD, from the Joslin Diabetes Center in Boston, Mass, and colleagues. "Recognizing the link between BG monitoring and improved glycemic control, [we] designed an educational booklet, the Blood Sugar Monitoring Owner’s Manual (BGMOM), with the goal of improving the physical and emotional well-being of patients with diabetes by increasing adherence to BG monitoring."

Of the 199 participants who were recruited from a multidisciplinary diabetes clinic and who had high-risk diabetes (hemoglobin A1C, >/= 8.0%), 35% had type 1 diabetes mellitus. These 199 participants were randomized to 1 of 3 groups: BGMOM intervention (BGM+), attention control (BG meter only [MT]), or standard care. The BGM+ and MT groups received BG meters and meter education, and the BGM+ group also received BGMOM booklets. During 6 months of follow-up, the investigators determined BG monitoring frequency and hemoglobin A1C measurement.

Monitoring frequency increased significantly in the BGM+ group, from 1.9 ± 1.3 to 2.8 ± 1.5 times daily (P < .001). In the MT group, monitoring frequency increased only slightly, from 1.7 ± 1.3 to 2.0 ± 1.3 times daily. The BGM+ group had the greatest improvement in hemoglobin A1C level (BGM+, -0.13 ± 1.28; MT, -0.04 ± 1.31; standard care, 0.04 ± 1.10) and the highest percentage of those who improved glycemic control (61% vs 44% in the other groups; P = .05). Compared with the other groups, the BGM+ group displayed the most knowledge about the definition of hemoglobin A1C (P = .04) and reported the least amount of negative effect concerning out-of-range BG monitoring results (P = .03).

"As an adjunct to standard diabetes education and support, a manual such as the BGMOM can help optimize BG monitoring and glycemic control," the authors write. "A simple-to-use, easily distributable tool like the BGMOM can positively affect patients’ diabetes self-management without straining personnel or financial resources. The incorporation of a manual, such as the BGMOM, as an adjunct to regular health care visits may enhance diabetes self-care and improve health outcomes while imposing minimal requirements of time, expense, and diabetes-specific expertise on health care professionals."
Arch Intern Med. March 27, 2006;166:689-695

================================

FACT:
Glufast Is A New Insulinotropic Agent With Rapid Onset, which may be coming to market soon. Mitiglinide calcium hydrate (mitiglinide, Glufast) is a new insulinotropic agent of the glinide class with rapid onset. Mitiglinide is thought to stimulate insulin secretion by closing the ATP-sensitive K(+) (K(ATP)) channels in pancreatic beta-cells, and its early insulin release and short duration of action would be effective in improving postprandial hyperglycemia. In studies mitiglinide was more potent than that of nateglinide, and mitiglinide controlling postprandial hyperglycemia. Folia Pharmacologica Japonica Vol. 124 (2004) , No. 4 245-255, Ojima K, Kiyono Y, Kojima M. See Item #1 from this weeks newsletter.