Effect of structured self-monitoring of blood glucose, with and without additional TeleCare support, on overall glycaemic control in non-insulin treated Type 2 diabetes

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Posted Jul 26 , 2019 01:46 AM

Effect of structured self-monitoring of blood glucose, with and without additional TeleCare support, on overall glycaemic control in non-insulin treated Type 2 diabetes: the SMBG Study, a 12-month randomized controlled trial.
Parsons SN, et al. Diabetic Medicine 2019;36:578-590

Institute Summary (excerpted from the abstract)

The objective of this study was to examine the impact of structured self-monitoring of blood glucose, with or without TeleCare support, on glycaemic control in people with sub-optimally controlled Type 2 diabetes. The authors conducted a 12-month, multicentre, randomized controlled trial in people with established (>1 year) Type 2 diabetes not on insulin therapy, with sub-optimal glycaemic control [HbA1c ≥7.5% to ≤13%]. A total of 446 participants were randomized to a control group (n =151) receiving usual diabetes care, a group using structured self-monitoring of blood glucose alone (n =147) or a group using structured self-monitoring of blood glucose with additional monthly TeleCare support (n =148). The primary outcome was HbA1c at 12 months. A total of 323 participants (72%) completed the study; 116 (77%) in the control group, 99 (67%) in the self-monitoring of blood glucose alone group and 108 (73%) in the self-monitoring of blood glucose plus TeleCare group. Compared to baseline, the mean HbA1c was lower in all groups at 12 months, with reductions of 0.3% in the control group, 1.1% in the group using self-monitoring of blood glucose alone and 1.2% in the group using self-monitoring of blood glucose plus TeleCare. This represents a reduction in HbA1c of 0.8% with structured self-monitoring of blood glucose compared to the control group. Participants with lower baseline HbA1c, shorter duration of diabetes and higher educational achievement were more likely to achieve HbA1c ≤ 7.0%.

Why is this important?

Structured self-monitoring of blood glucose has been shown to be more effective in improving glucose control in several studies. In this study, the participants were asked to measure their BG levels after fasting, 2 h after breakfast, and before and 2 h after their main meal on 2 days each week. During the week prior to study visits at months 3, 6 and 9, participants were as to perform a seven-point BG profile (before and 2 h after three main meals, and at bedtime) on 3 days. Meter downloads, software to chart glucose values and instructions on how to use the data were provided to patients by the study nurses. Consistent with other studies (Polonsky WH, et al. Diabetes Care 2011;34:262-267), structured self-monitoring of blood glucose provides clinical and statistical improvements in glycemic control in type 2 diabetes. In this trial Telecare consisted of a monthly phone call and discussion of the past month’s results, which was a minimal telephone intervention, and as might be expected, showed no additional benefit over and above the use of structured self-monitoring of blood glucose. This study is a great example of structured testing and the use of the data.

Concluding Thought:
“Structure significantly influences behavior, thereby dramatically impacting results.”
- Chris Hutchinson

Read the Article:
https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.13899