Benefits of self‐monitoring blood glucose in the management of new‐onset Type 2 diabetes mellitus: The St Carlos Study, a prospective randomized clinic‐based interventional study with parallel groups

Abstract

Background: Intensive treatment of patients with Type 2 diabetes mellitus (T2DM) from the moment of diagnosis facilitates β‐cell recovery. Self‐monitoring of blood glucose (SMBG)‐based educational and pharmacological intervention may be better than conventional HbA1c algorithms in the treatment of newly diagnosed T2DM. Methods: Newly diagnosed T2DM patients were randomized to either an SMBG‐based intervention or an HbA1c‐based control group (n = 99 and 62, respectively) and were followed for 1 year. Results: Higher rates of diabetes regression (HbA1c < 6% on metformin alone) and remission (HbA1c between 6.0% and 6.4%) were achieved in the intervention compared with the control group (39% vs 5% (P < 0.001) and 37% vs 30% (P < 0.01), respectively). Furthermore, significantly greater reductions in median HbA1c (6.6% to 6.1%; P < 0.05) and body mass index (29.6–27.9 kg/m2; P < 0.001) were seen in the intervention over the 1 year of therapy. The percentage of patients achieving a lifestyle score >12 was significantly greater in the SMBG compared with the control group (38.4% vs 9.7% respectively; P < 0.001). An inverse correlation was observed between SMBG and HbA1c levels (P < 0.04). Conclusions: The results indicate that SMBG‐based structured educational and pharmacological programs empower patients to achieve nutritional and physical activity goals, and encourage physicians and patients to use SMBG to optimize therapy. We believe that the concept of intensive treatment of T2DM patients should be modified; instead of referring to the type of treatment (insulin use), the term should reflect the intensity with which we work to reach glucose objectives.

Higher Accuracy of Self-Monitoring of Blood Glucose in Insulin-Treated Patients in Germany: Clinical and Economical Aspects

“…55 The evidence for the clinical benefit of SMBG in diabetes is increasing. 9,11,[56][57][58] The current study supports the view that SMBG is cost-effective and contrasts with some previous observations. [12][13][14]59,60 These studies, however, were criticized for not having included a structured educational and therapeutic component in response to BG values.…”

“…[6][7][8] Studies, e.g., Structured Testing Program and Role of Self-Monitoring of Blood Glucose and Intensive Education, San Carlos, highlight the value of structured SMBG in type 2 diabetes. [9][10][11] Despite the growing evidence for the benefit of SMBG, the potential value of SMBG in type 2 diabetes is still being debated. [12][13][14] The reliability of self-monitored glucose values is a prerequisite for an efficient and safe approach to treat patients to their target.…”

Blood glucose monitoring in type 2 diabetes – Nepalese patients’ opinions and experiences

“…Some participants in Australia reported using HBGM to not only monitor their diabetes, but also to understand the impact of diet and exercise on their blood glucose levels. However, in Nepal, the idea that HBGM could facilitate patient empowerment and self-management [2,29] appeared poorly understood.…”

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

“…The strength of the evidence for short-term mortality was graded as moderate, given that results were precise, direct, and had low risk of bias (Table 2). Table 7), 4,21,49,61,62,69,[72][73][74][75][76][77][78][79][80][81][82][83] showing no clear differences between groups in hypoglycemia. The strength of evidence was graded as low, given the inconsistency and imprecision of the results (Table 2).…”

“…Most studies reported hypoglycemia as total hypoglycemic events [75][76][77] (N=5) or p a r t i c i p a n t s e x p e r i e n c i n g h y p o g l y c e m i a ( N = 8). 61,62,69,73,74,78,80,82 Hypoglycemic outcomes were defined heterogeneously, with some studies based on self report 4,21,62,72,73,77,82 and others on glucose readings. 74,76,78 Twelve of the 18 studies reported measures of variability.…”