Intensified blood glucose monitoring improves glycemic control in stable, insulin-treated veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study (DOVES).

OBJECTIVE To examine the effect of intensified self-monitored blood glucose (SMBG) testing on glycemic control. RESEARCH DESIGN AND METHODS Subjects with stable, insulin-treated type 2 diabetes performed SMBG using an electronic blood glucose meter before all meals and at bedtime for 8 weeks. Baseline data were collected on demographics, clinical characteristics, diet, and exercise. HbA(1c) was measured at baseline, at 4 weeks, and at 8 weeks. After the intensified monitoring period, subjects resumed their usual monitoring. HbA(1c) was then measured at 24, 37, and 52 weeks. Multivariate linear regression was used to determine the effect of monitoring on glycemic control. RESULTS A total of 201 subjects completed the monitoring period. The baseline HbA(1c) (8.10 +/- 1.67%) decreased during the monitoring period by 0.30 +/- 0.68% (P < 0.001) at 4 weeks and by 0.36 +/- 0.88% (P < 0.001) at 8 weeks. Although entry HbA(1c) and compliance independently predicted the week 8 HbA(1c) (r = 0.862, P < 0.001), standardized regression analysis found that compliance with the SMBG protocol influenced the week 8 HbA(1c) more than age, sex, BMI, exercise level, carbohydrate consumption, or treatment intensity at baseline. However, SMBG benefited only subjects whose testing compliance exceeded 75% or with an entry HbA(1c) >8.0%. Decreases in HbA(1c) (-0.31 +/- 1.17%, P = 0.001) persisted in the 159 subjects followed for 52 weeks. CONCLUSIONS Intensified blood glucose monitoring improved glycemic control in a large cohort of stable, insulin-treated veterans with type 2 diabetes. SMBG provided a strong stimulus for improved self-care resulting in clinically important and sustained reductions in HbA(1c).

[1]  M D Thornquist,et al.  Development and validation of a food use checklist for evaluation of community nutrition interventions. , 1990, American journal of public health.

[2]  G. Rutten,et al.  Feasibility and effects of a diabetes type II protocol with blood glucose self-monitoring in general practice. , 1990, Family practice.

[3]  J. Oki,et al.  Frequency and Impact of SMBG on Glycemic Control in Patients With NIDDM in an Urban Teaching Hospital Clinic , 1997, The Diabetes educator.

[4]  U. Müller,et al.  Blood-glucose self-monitoring in insulin treated type 2 diabetes mellitus a cross-sectional study with an intervention group. , 1999, Diabetes & metabolism.

[5]  D. Kerr,et al.  Comparison of blood or urine testing by patients with newly diagnosed non-insulin dependent diabetes: patient survey after randomised crossover trial , 1997, BMJ.

[6]  W. Newman,et al.  Impact of glucose self-monitoring on glycohemoglobin values in a veteran population. , 1990, Archives of internal medicine.

[7]  D. Muchmore,et al.  Self-monitoring of blood glucose in overweight type 2 diabetic patients , 1994, Acta Diabetologica.

[8]  M. Gallichan.  Self‐monitoring by patients receiving oral hypoglycaemic agents: A survey and a comparative trial , 1994 .

[9]  S. Glantz,et al.  Primer of Applied Regression & Analysis of Variance , 1990 .

[10]  J. Rindone,et al.  Effect of home blood glucose monitoring on the management of patients with non-insulin dependent diabetes mellitus in the primary care setting. , 1997, The American journal of managed care.

[11]  S H Kaplan,et al.  The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies. , 2001, Diabetes care.

[12]  M. Harris,et al.  Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. , 2001, Diabetes care.

[13]  L. Kennedy.  Self-monitoring of blood glucose in type 2 diabetes: time for evidence of efficacy. , 2001, Diabetes care.

[14]  D. Ruta,et al.  Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database , 1999, BMJ.

[15]  L. Epstein,et al.  Does self-monitoring of blood glucose levels improve dietary compliance for obese patients with type II diabetes? , 1986, The American journal of medicine.

[16]  Jennifer Y. Liu,et al.  Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry. , 2001, The American journal of medicine.

[17]  W. Duckworth,et al.  Risk factor management in stable, insulin-treated patients with Type 2 diabetes: the Diabetes Outcomes in Veterans Study. , 2003, Journal of diabetes and its complications.

[18]  S. Glantz.  Primer of applied regression and analysis of variance / Stanton A. Glantz, Bryan K. Slinker , 1990 .

[19]  K. Mann,et al.  Follow-up Intervention: Its Effect on Compliance Behavior to a Diabetes Regimen , 1990, The Diabetes educator.

[20]  M. Gulliford,et al.  Self‐monitoring in Type 2 diabetes mellitus: a meta‐analysis , 2000, Diabetic medicine : a journal of the British Diabetic Association.

[21]  G. Slama,et al.  Is glucose self-monitoring beneficial in non-insulin-treated diabetic patients? Results of a randomized comparative trial. , 1989, Diabete & metabolisme.

[22]  F. Schellevis,et al.  The Efficacy of Self-Monitoring of Blood Glucose in NIDDM subjects: A criteria-based literature review , 1997, Diabetes Care.

[23]  A. Patrick,et al.  Home Glucose Monitoring in Type 2 Diabetes: Is It a Waste of Time? , 1994, Diabetic medicine : a journal of the British Diabetic Association.

[24]  J F Sallis,et al.  Compendium of physical activities: classification of energy costs of human physical activities. , 1993, Medicine and science in sports and exercise.

[25]  E. DeLong,et al.  Impact of Glucose Self-Monitoring on Non-lnsulin-Treated Patients With Type II Diabetes Mellitus: Randomized Controlled Trial Comparing Blood and Urine Testing , 1990, Diabetes Care.