Posted Apr 19 , 2019 09:12 AM
Self-Monitoring of Blood Glucose in Youth-Onset Type 2 Diabetes: Results from the TODAY Study.
Weinstock RS, et al. Diabetes Care 2019 Online March 4th
Institute Summary (excerpted from the Abstract):
The purpose of this analysis was to determine whether self-monitoring of blood glucose (SMBG) is associated with lower HbA1c in youth with type 2 diabetes taking oral medications only or after starting insulin for persistently elevated HbA1c. Participants in the TODAY trial (n = 699) taking oral medications were asked to perform SMBG twice daily. After reaching primary outcome (PO) (HbA1c > 8% [64 mmol/mol]) over 6 months or an inability to wean from temporary insulin because of metabolic decompensation), insulin glargine was started. HbA1c and percent of SMBG (SMBG %) (percent days when the meter was used one or more times) before and after reaching the PO were analyzed. SMBG declined over time and was inversely related to HbA1c (P < 0.0001). Of 298 youth who reached PO and started insulin, 282 had SMBG data. At PO, (mean + SD) age was 15.8 + 2.3 years, BMI 35.5 +7.9 kg/m2, and HbA1c 9.6 + 2.0% (81 + 21.9 mmol/mol); 65.3% were female. Median SMBG% was 40% at PO, which increased to 49% after 6 months and fell to 41% after 1 year on insulin. At PO, 22% of youth checked > 80% of days, which increased to 25% and fell to 19% after 6 and 12 months using insulin, respectively. At PO, compared with those who checked < 80%, youth who checked > 80% were younger and with a lower BMI, HbA1c, and blood pressure. SMBG > 80% was associated with > 1% reduction in HbA1c at 6 and 12 months after insulin initiation.
Why is this important?
Low SMBG adherence was common and associated with higher HbA1c, which has been seen in a number of studies. SMBG is of value in type 2 diabetes patients with and without intensive management (Machry RV, et al. Diabetes Research and Clinical Practice 2018;142:173-187). Optimal SMBG frequency in youth using or not using insulin, and whether less frequent SMBG is a marker for overall worse self-care, require further study. The most important thing to remember is that what the patients DO with the SMBG result and how it is interpreted in light of diet and exercise for the individual as well as whether medication changes are needed. Performing SMBG allows the personal discovery of learning how various foods or activities affect blood glucose, which is clearly one of the more important aspects of helping patients USE the SMBG information to make better choices (Mamykina L, et al. Journal of Biomedical Informatics 2017;76:1-8) When you counsel your patients on how best to utilize SMBG do you structure a testing/discovery program for them to use to see the value of SMBG information?
Read the Abstract: