OBJECTIVE -The role of self-monitoring of blood glucose (SMBG) in type 2 diabetes is still a matter of debate. In the framework of a nationwide outcomes research program, we investigated the frequency of SMBG and its association with metabolic control and quality of life (QoL).RESEARCH DESIGN AND METHODS -The study involved 3,567 patients with type 2 diabetes who were recruited by 101 outpatient diabetes clinics and 103 general practitioners. Patients completed a questionnaire investigating SMBG practice and QoL (diabetes-related stress, diabetes health distress, diabetes-related worries, and Centers for Epidemiologic StudiesDepression scale).RESULTS -Data on SMBG were available for 2,855 subjects (80% of the entire study population). Overall, 471 patients (17%) stated that they tested their blood glucose levels at home Ն1 time per day, 899 patients (31%) tested their blood glucose levels Ն1 time per week, and 414 patients (14%) tested their blood glucose levels Ͻ1 time per week, whereas 1,071 patients (38%) stated that they never practiced SMBG. A higher frequency of SMBG was associated with better metabolic control among subjects who were able to adjust insulin doses, whereas no relationship was found in all other patients, irrespective of the kind of treatment. Multivariate analyses showed that an SMBG frequency Ն1 time per day was significantly related to higher levels of distress, worries, and depressive symptoms in non-insulin-treated patients.CONCLUSIONS -Our findings suggest that SMBG can have an important role in improving metabolic control if it is an integral part of a wider educational strategy devoted to the promotion of patient autonomy. In patients not treated with insulin, self-monitoring is associated with higher HbA 1c levels and psychological burden. Our data do not support the extension of SMBG to this group.

Our data suggest that, by removing avoidable risk factors, the number of diabetic complications considered could be reduced by more than one-third. The case-control methodology represents an efficient way of monitoring clinical practice and relating it to important outcomes. It can be of help for policy makers in identifying the more effective strategies and in tailoring specific interventions aimed at improving the quality of the care delivered to diabetic patients.

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RESEARCH DESIGN AND METHODS -Physicians' beliefs were investigated through a questionnaire sent to a sample of self-selected clinicians participating in a nationwide initiative aimed at assessing the relationship between the quality of care delivered to patients with type 2 diabetes and their outcomes. At the same time, physicians were asked to collect clinical data on a random sample of their patients, stratified by age (Ͻ65 vs. Ն65 years). Mean HbA 1c levels in the study population were thus evaluated according to target fasting blood glucose (FBG) used by their physicians.RESULTS -Of 456 physicians, 342 (75%) returned the questionnaire. Among the responders, 200 diabetologists and 99 general practitioners (GPs) recruited 3,297 patients; 2,003 of whom were always followed by the same physician and 1,294 of whom were seen by different physicians in the same structure on different occasions. Only 14% of the respondents used target FBG levels Յ6.1 mmol/l, whereas 38% pursued values Ͼ7.8 mmol/l, with no statistically significant difference between diabetologists and GPs. The analysis of the relationship between FBG targets and metabolic control, restricted to those patients always seen by the same physician, showed a strong linear association, with mean HbA 1c values of 7.0 Ϯ 1.6 for patients in the charge of physicians pursuing FBG levels Յ6.1 mmol/l and 7.8 Ϯ 1.8 for those followed by physicians who used target values Ͼ7.8 mmol/l. After adjusting for patients' and physicians' characteristics, the risk of having HbA 1c values Ͼ7.0% was highly correlated with physicians' beliefs. Patients followed by different physicians in the same unit showed a risk of inadequate metabolic control similar to that of patients followed by physicians adopting a nonaggressive policy.CONCLUSIONS -Doctors adopt extremely heterogeneous target FBG levels in patients with type 2 diabetes, which in turn represent an important independent predictor of metabolic control. To improve patient outcomes, physicians-centered educational activities aimed at increasing the awareness of the potential benefits of a tight metabolic control in patients with type 2 diabetes are urgently needed. Diabetes Care 24:423-429, 2001T he recent results of the U.K. Prospective Diabetes Study (UKPDS) have confirmed, for type 2 diabetes, that intensive blood-glucose control substantially decreases the risk of developing complications of diabetes (1).However, how this information translates into a balance among the need for improving metabolic control, the fear of unwanted hypoglycemic effects, and the burden imposed by more intense treatment is not clear. We studied this translation in the context of the QuED Project, a nationwide initiative aimed at assessing the relationship between the quality of