Posted Oct 17 , 2019 04:30 AM
Frequency of self-monitoring of blood glucose in relation to weight loss and A1C during intensive multidisciplinary weight management in patients with type 2 diabetes and obesity.
Tomah S, et al. BMJ Open Diab Res Care 2019;7:e000659.
Institute Summary (excerpted from the abstract)
The authors evaluated the relationship between frequency of self-monitoring of blood glucose (SMBG) and body weight, A1C, and cardiovascular risk factors in patients with type 2 diabetes (T2D) and obesity enrolled in a 12-week intensive multidisciplinary weight management (IMWM) program. The study is a retrospective analysis of 42 patients who electronically uploaded their SMBG data over 12 weeks of an IMWM program and divided them into tertiles based on their average frequency of SMBG per day. Mean SMBG frequencies were 2.3 times/day, 3.4 times/day, and 5 times/day in the lowest, middle, and highest tertiles, respectively. Anthropometric and metabolic parameters were measured at baseline and after 12 weeks of intervention. Participants in the highest tertile achieved a median change (IQR) in body weight of −10.4 kg compared with −8.3 kg and −6.9 kg in the middle and lowest tertiles, respectively. Participants in the highest tertile had a median change (IQR) in A1C of −1.25% compared with −0.8% and −0.5% in the middle and lowest tertiles, respectively. The association between change in body weight and SMBG frequency remained significant after adjusting for age, sex, baseline body mass index, diabetes duration, and use of insulin therapy.
Why is this important?
Many patients with type 2 diabetes and a fair number with type 1 diabetes need to reduce their weight. In this study of people with type 2 diabetes, increased frequency of SMBG during IMWM is associated with significantly better weight loss and improvement of A1C in patients with T2D and obesity. These findings may suggest future clinical recommendations aimed at increasing SMBG frequency to achieve the most favorable outcomes. While this association is important, it should be evaluated in light of other variables such as willingness to adhere to a diet, willingness to perform frequent weight measurements, and the change in therapy from weight gain-promoting medications which were substituted, whenever possible, with weight neutral or weight loss-promoting medications. These patients received medical nutrition therapy, exercise intervention and behavioral counseling as well as the ability to perform self-monitoring of blood glucose. Outcomes from this program (Why WAIT) have been published previously (Hamdy O, et al BMJ Open Diabetes Res Care. 2017;5:e000259, and, Mottalib A, et al J Diabetes Res. 2015;2015:468704), and the results from this 12 week Joslin program are both impressive and for the most part sustained over time. While SMBG may well play an important role in programs such as this, its major benefit is helping individuals see what changes occur with different foods and exercise, and incorporating these observations to aid in lifestyle modifications. The association between SMBG frequency and outcomes in this study is clear, but simply recommending more testing without using the data in making lifestyle changes is likely not enough. Do you teach patients about how to use SMBG data to make diet and exercise changes? Your colleagues would love to hear your processes and successes!
Concluding Thought: The complexities of cause and effect defy analysis _Douglas Adams
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