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Parsons S, Luzio S, Bain S, Harvey J, McKenna J, Khan A, Rice S, Watkins A, Owens DR. Self-monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes (The SMBG Study): study protocol for a randomised controlled trial. BMC Endocr Disord 2017; 17:4. [PMID: 28143495 PMCID: PMC5286854 DOI: 10.1186/s12902-017-0154-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/18/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The benefit of Self-monitoring of Blood Glucose (SMBG) in people with non-insulin treated type 2 diabetes remains unclear with inconsistent evidence from randomised controlled trials fuelling the continued debate. Lack of a consistent finding has been attributed to variations in study population and design, including the SMBG intervention. There is a growing consensus that structured SMBG, whereby the person with diabetes and health care provider are educated to detect patterns of glycaemic abnormality and take appropriate action according to the blood glucose profiles, can prove beneficial in terms of lowering HbA1c and improving overall well-being. Despite this, many national health agencies continue to issue guidelines restricting the use of SMBG in non-insulin treated type 2 diabetes. METHODS The SMBG Study is a 12 month, multi-centre, randomised controlled trial in people with type 2 diabetes not on insulin therapy who have poor glycaemic control (HbA1c ≥58 mmol/mol / 7.5%). The participants will be randomised into three comparative groups: Group 1 will act as a control group and receive their usual diabetes care; Group 2 will undertake structured SMBG with clinical review every 3 months; Group 3 will undertake structured SMBG with additional monthly telecare support from a trained study nurse. A total of 450 participants will be recruited from 16 primary and secondary care sites across Wales and England. The primary outcome measure will be HbA1c at 12 months with secondary measures to include weight, BMI, total cholesterol and HbA1c levels at 3, 6, 9 and 12 months. Participant well-being and attitude towards SMBG will be monitored throughout the course of the study. Recruitment began in December 2012 with the last participant visit due in September 2016. DISCUSSION This study will attempt to answer the question of whether structured SMBG provides any benefits to people with poorly controlled type 2 diabetes who are not being treated with insulin. The data will also clarify whether the telecare support provides additional value. The overall acceptability of SMBG as a tool for self-management will be assessed. TRIAL REGISTRATION UKCRN 12038 (Registered March 2012). ISRCTN21390608 (Retrospectively registered 15th May 2014).
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Affiliation(s)
- Sharon Parsons
- Diabetes Research Unit, Swansea University, Institute of Life Sciences, Singleton Park, Swansea, SA2 8PP UK
| | - Stephen Luzio
- Diabetes Research Unit, Swansea University, Institute of Life Sciences, Singleton Park, Swansea, SA2 8PP UK
| | - Stephen Bain
- Diabetes Research Unit, Swansea University, Institute of Life Sciences, Singleton Park, Swansea, SA2 8PP UK
| | - John Harvey
- Diabetes Centre, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Jillian McKenna
- Diabetes Research Unit, Swansea University, Institute of Life Sciences, Singleton Park, Swansea, SA2 8PP UK
| | - Atir Khan
- Diabetes Centre, Glangwili Hosptial, Hywel Dda University Health Board, Carmarthen, UK
| | - Sam Rice
- Diabetes Centre, Prince Philip Hospital, Hywel Dda University Health Board, Llanelli, UK
| | - Alan Watkins
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - David R. Owens
- Diabetes Research Unit, Swansea University, Institute of Life Sciences, Singleton Park, Swansea, SA2 8PP UK
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Guo X, Wang Y, Ma Y, Wang J, Lu G, Chen L, Huang Y, Beer A, Dong L, Peng Y. Accuracy Evaluation of a Blood Glucose Monitoring System in Chinese Individuals. J Diabetes Sci Technol 2016; 10:1416-1418. [PMID: 27257170 PMCID: PMC5094329 DOI: 10.1177/1932296816651882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Yufei Wang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuhang Ma
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianbo Wang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guizhi Lu
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Lan Chen
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Youyuan Huang
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Alexandra Beer
- Sanofi-Aventis Deutschland GmbH, Device Development, Frankfurt, Germany
| | - Li Dong
- Sanofi Asia & Pacific R&D, Shanghai, China
| | - Yongde Peng
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
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Kempf K, Tankova T, Martin S. ROSSO-in-praxi-international: long-term effects of self-monitoring of blood glucose on glucometabolic control in patients with type 2 diabetes mellitus not treated with insulin. Diabetes Technol Ther 2013. [PMID: 23194054 DOI: 10.1089/dia.2012.0213] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Effects of lifestyle change on blood glucose levels can be monitored by self-monitoring of blood glucose (SMBG) in type 2 diabetes mellitus (T2DM) patients. We analyzed whether the SMBG-structured lifestyle intervention program ROSSO-in-praxi-international can improve glucometabolic control in the short and the long term. SUBJECTS AND METHODS One hundred twenty-four SMBG-naive ambulatory non-insulin-treated T2DM patients were randomly assigned to an SMBG group (n=63) and a control group (n=61). Both groups received a 12-week structured lifestyle guidance manual. The SMBG group additionally got a blood glucose meter with 150 test strips and was instructed to measure blood glucose regularly as well as event-driven. Glucometabolic parameters were assessed at baseline, after 12 weeks, and after 1.5 years. RESULTS During the 12 weeks of intervention the SMBG group significantly improved glycated hemoglobin (HbA1c) levels (from 7.4 ± 1.6% to 6.9 ± 1.1% [P<0.001]) and weight (-0.9 ± 1.9 kg [P<0.05]), whereas HbA1c reduction (from 7.5 ± 1.0% to 7.3 ± 1.0%) and weight loss (-0.6 ± 2.4 kg) were not significant in the control group. Of the 124 patients, 122 completed the 1.5-year follow-up. In the control group HbA1c increased again, reaching baseline values (7.5 ± 0.7%). In the SMBG group HbA1c remained stable (6.9 ± 0.9% [P=0.0003 for trend]), and weight (-1.6 ± 3.0 kg vs. baseline [P=0.0003 for trend]) improved further. Eighty-seven percent of participants in the SMBG group continued to perform SMBG. Those who measured their blood glucose more than three times per week (n=24) demonstrated an overall reduction in HbA1c of 1.0% (P=0.006 vs. three times or fewer per week) after 1.5 years. CONCLUSIONS Integration of SMBG into basic therapy of T2DM for monitoring the effect of lifestyle changes improves glucometabolic control and has long-term effects.
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Affiliation(s)
- Kerstin Kempf
- West-German Centre of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany.
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McAndrew LM, Napolitano MA, Pogach LM, Quigley KS, Shantz KL, Vander Veur SS, Foster GD. The impact of self-monitoring of blood glucose on a behavioral weight loss intervention for patients with type 2 diabetes. DIABETES EDUCATOR 2012; 39:397-405. [PMID: 22735195 DOI: 10.1177/0145721712449434] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the study was to examine the association of self-monitoring of blood glucose (SMBG) to weight loss and A1C among participants in a behavioral weight loss intervention. METHODS Multivariate analyses were employed to evaluate the relationship between SMBG and changes in patient weight and A1C levels. Bootstrapping was used to determine whether there was an indirect effect of SMBG on weight loss through diet adherence and an indirect effect of SMBG on A1C through weight loss. RESULTS The relationship between increased SMBG and greater weight loss was mediated by better adherence to diet. The relationship of increased SMBG and greater reductions in A1C were mediated by greater weight loss. CONCLUSIONS Results of the study were consistent with the hypothesis that SMBG leads to an increased adherence to dietary recommendations. For patients who are taught to use their diet to lose weight, increased adherence to dietary recommendations is associated with increased weight loss and subsequently better glucose control. SMBG may be of value as an adjunctive intervention in behavioral programs for type 2 diabetes.
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Affiliation(s)
- Lisa M McAndrew
- The Department of Veterans Affairs New Jersey Healthcare System, War Related Illness and Injury Study Center, East Orange, New Jersey (Dr McAndrew),The University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey (Dr Pogach, Dr McAndrew)
| | - Melissa A Napolitano
- Temple University, Departments of Kinesiology and Public Health and Center for Obesity Research and Education, Philadelphia, Pennsylvania (Dr Napolitano)
| | - Leonard M Pogach
- Department of Veterans Affairs New Jersey Healthcare System, Center for Healthcare Knowledge Management, East Orange, NJ (Dr Pogach),The University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey (Dr Pogach, Dr McAndrew)
| | - Karen S Quigley
- The Center for Health Quality, Outcomes, Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, and the Department of Psychology, Northeastern University, Boston, MA (Dr Quigley)
| | - Kerri Leh Shantz
- Temple University, Center for Obesity Research and Education, Philadelphia, Pennsylvania (Dr Foster, Ms. Shantz, Ms. Vander Veur)
| | - Stephanie S Vander Veur
- Temple University, Center for Obesity Research and Education, Philadelphia, Pennsylvania (Dr Foster, Ms. Shantz, Ms. Vander Veur)
| | - Gary D Foster
- Temple University, Center for Obesity Research and Education, Philadelphia, Pennsylvania (Dr Foster, Ms. Shantz, Ms. Vander Veur)
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Pfützner A, Mitri M, Musholt PB, Sachsenheimer D, Borchert M, Yap A, Forst T. Clinical assessment of the accuracy of blood glucose measurement devices. Curr Med Res Opin 2012; 28:525-31. [PMID: 22435798 DOI: 10.1185/03007995.2012.673479] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Blood glucose meters for patient self-measurement need to comply with the accuracy standards of the ISO 15197 guideline. We investigated the accuracy of the two new blood glucose meters BG*Star and iBG*Star (Sanofi-Aventis) in comparison to four other competitive devices (Accu-Chek Aviva, Roche Diagnostics; FreeStyle Freedom Lite, Abbott Medisense; Contour, Bayer; OneTouch Ultra 2, Lifescan) at different blood glucose ranges in a clinical setting with healthy subjects and patients with type 1 and type 2 diabetes. BGStar and iBGStar are employ dynamic electrochemistry, which is supposed to result in highly accurate results. METHODS The study was performed on 106 participants (53 female, 53 male, age (mean ± SD): 46 ± 16 years, type 1: 32 patients, type 2: 34 patients, and 40 healthy subjects). Two devices from each type and strips from two different production lots were used for glucose assessment (∼200 readings/meter). Spontaneous glucose assessments and glucose or insulin interventions under medical supervision were applied to perform measurements in the different glucose ranges in accordance with the ISO 15197 requirements. Sample values <50 mg/dL and >400 mg/dL were prepared by laboratory manipulations. The YSI glucose analyzer (glucose oxidase method) served as the standard reference method which may be considered to be a limitation in light of glucose hexokinase-based meters. RESULTS For all devices, there was a very close correlation between the glucose results compared to the YSI reference method results. The correlation coefficients were r = 0.995 for BGStar and r = 0.992 for iBGStar (Aviva: 0.995, Freedom Lite: 0.990, Contour: 0.993, Ultra 2: 0.990). Error-grid analysis according to Parkes and Clarke revealed both 100% of the readings to be within the clinically acceptable areas (Clarke: A + B with BG*Star (100 + 0), Aviva (97 + 3), and Contour (97 + 3); and 99.5% with iBG*Star (97.5 + 2), Freedom Lite (98 + 1.5), and Ultra 2 (97.5 + 2)). CONCLUSIONS This study demonstrated the very high accuracy of BG*Star, iBG*Star, and the competitive blood glucose meters in a clinical setting.
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Affiliation(s)
- Andreas Pfützner
- IKFE - Institute for Clinical Research and Development, Mainz, Germany.
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Malanda UL, Welschen LMC, Riphagen II, Dekker JM, Nijpels G, Bot SDM. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev 2012; 1:CD005060. [PMID: 22258959 DOI: 10.1002/14651858.cd005060.pub3] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) has been found to be effective for patients with type 1 diabetes and for patients with type 2 diabetes using insulin. There is much debate on the effectiveness of SMBG as a tool in the self-management for patients with type 2 diabetes who are not using insulin. OBJECTIVES To assess the effects of SMBG in patients with type 2 diabetes mellitus who are not using insulin. SEARCH METHODS Multiple electronic bibliographic and ongoing trial databases were searched supplemented with handsearches of references of retrieved articles (date of last search: 07 July 2011). SELECTION CRITERIA Randomised controlled trials investigating the effects of SMBG compared with usual care, self-monitoring of urine glucose (SMUG) or both in patients with type 2 diabetes who where not using insulin. Studies that used glycosylated haemoglobin A(1c) (HbA(1c)) as primary outcome were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two authors independently extracted data from included studies and evaluated the studies' risk of bias. Data from the studies were compared to decide whether they were sufficiently homogeneous to pool in a meta-analysis. Primary outcomes were HbA(1c), health-related quality of life, well-being and patient satisfaction. Secondary outcomes were fasting plasma glucose level, hypoglycaemic episodes, morbidity, adverse effects and costs. MAIN RESULTS Twelve randomised controlled trials were included and evaluated outcomes in 3259 randomised patients. Intervention duration ranged from 6 months (26 weeks) to 12 months (52 weeks). Nine trials compared SMBG with usual care without monitoring, one study compared SMBG with SMUG, one study was a three-armed trial comparing SMBG and SMUG with usual care and one study was a three-armed trial comparing less intensive SMBG and more intensive SMBG with a control group. Seven out of 11 studies had a low risk of bias for most indicators. Meta-analysis of studies including patients with a diabetes duration of one year or more showed a statistically significant SMBG induced decrease in HbA(1c) at up to six months follow-up (-0.3; 95% confidence interval (CI) -0.4 to -0.1; 2324 participants, nine trials), yet an overall statistically non-significant SMBG induced decrease was seen at 12 month follow-up (-0.1; 95% CI -0.3 to 0.04; 493 participants, two trials). Qualitative analysis of the effect of SMBG on well-being and quality of life showed no effect on patient satisfaction, general well-being or general health-related quality of life. Two trials reported costs of self-monitoring: One trial compared the costs of self-monitoring of blood glucose with self-monitoring of urine glucose based on nine measurements per week and with the prices in US dollars for self-monitoring in 1990. Authors concluded that total costs in the first year of self-monitoring of blood glucose, with the purchase of a reflectance meter were 12 times more expensive than self-monitoring of urine glucose ($481 or 361 EURO [11/2011 conversion] versus $40 or 30 EURO [11/2011 conversion]). Another trial reported a full economical evaluation of the costs and effects of self-monitoring. At the end of the trial, costs for the intervention were £89 (104 EURO [11/2011 conversion]) for standardized usual care (control group), £181 (212 EURO [11/2011 conversion]) for the less intensive self-monitoring group and £173 (203 EURO [11/2011 conversion]) for the more intensive self-monitoring group. Higher losses to follow-up in the more intensive self-monitoring group were responsible for the difference in costs, compared to the less intensive self-monitoring group.There were few data on the effects on other outcomes and these effects were not statistically significant. None of the studies reported data on morbidity. AUTHORS' CONCLUSIONS From this review, we conclude that when diabetes duration is over one year, the overall effect of self-monitoring of blood glucose on glycaemic control in patients with type 2 diabetes who are not using insulin is small up to six months after initiation and subsides after 12 months. Furthermore, based on a best-evidence synthesis, there is no evidence that SMBG affects patient satisfaction, general well-being or general health-related quality of life. More research is needed to explore the psychological impact of SMBG and its impact on diabetes specific quality of life and well-being, as well as the impact of SMBG on hypoglycaemia and diabetic complications.
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Affiliation(s)
- Uriëll L Malanda
- Department of General Practice, EMGO Institute for Health and Care Research, VU UniversityMedical Center, PO Box 7057, Amsterdam, 1007 MB, Netherlands. .
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Kempf K, Kruse J, Martin S. ROSSO-in-praxi follow-up: long-term effects of self-monitoring of blood glucose on weight, hemoglobin A1c, and quality of life in patients with type 2 diabetes mellitus. Diabetes Technol Ther 2012; 14:59-64. [PMID: 21988274 DOI: 10.1089/dia.2011.0116] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) is a simple tool to monitor the effects of lifestyle change on blood glucose. Recently, the ROSSO-in-praxi Study demonstrated that addition of SMBG to a 12-week lifestyle intervention was associated with significant improvements in glucometabolic control and quality of life in insulin-naive patients with type 2 diabetes mellitus (T2DM). So far it is unknown if this short-term intervention also has long-term effects. Therefore, participants were followed up for a mean period of 2 years. METHODS Participants (n=327) were asked by mail for current weight, hemoglobin A1c (HbA1c), performance of SMBG, and quality of life (SF36 and CES-D questionnaires). Participants who did not reply were contacted by phone. RESULTS Two hundred twenty-eight participants (70%) completed the follow-up. During the 12-week lifestyle intervention they had significantly reduced weight (2.2 kg) and HbA1c (0.3%; P<0.001 each). After 2 years they achieved a further reduction of weight (0.2 kg; P<0.001), whereas HbA1c increased again, remaining 0.1% lower than baseline. The numbers of depressed participants remained stable during follow-up, whereas physical and mental health-related quality of life remained better compared with baseline. During follow-up 20% of participants continued SMBG daily, 35% several times a week, and 33% irregularly. It is interesting that participants with daily SMBG demonstrated an HbA1c decrease of 0.3% at time of follow-up, whereas in those who stopped SMBG HbA1c increased by 0.1% (P=0.05). CONCLUSIONS Integration of a short-term, motivational, and low-cost intervention into basic therapy of T2DM has had beneficial long-term effects on weight and quality of life and, if SMBG was continued daily, also on HbA1c.
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Affiliation(s)
- Kerstin Kempf
- West-German Centre of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany.
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Tunis SL. Cost effectiveness of self-monitoring of blood glucose (SMBG) for patients with type 2 diabetes and not on insulin: impact of modelling assumptions on recent Canadian findings. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2011; 9:351-365. [PMID: 21892840 DOI: 10.2165/11594270-000000000-00000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Canadian patients, healthcare providers and payers share interest in assessing the value of self-monitoring of blood glucose (SMBG) for individuals with type 2 diabetes but not on insulin. Using the UKPDS (UK Prospective Diabetes Study) model, the Canadian Optimal Prescribing and Utilization Service (COMPUS) conducted an SMBG cost-effectiveness analysis. Based on the results, COMPUS does not recommend routine strip use for most adults with type 2 diabetes who are not on insulin. Cost-effectiveness studies require many assumptions regarding cohort, clinical effect, complication costs, etc. The COMPUS evaluation included several conservative assumptions that negatively impacted SMBG cost effectiveness. OBJECTIVES Current objectives were to (i) review key, impactful COMPUS assumptions; (ii) illustrate how alternative inputs can lead to more favourable results for SMBG cost effectiveness; and (iii) provide recommendations for assessing its long-term value. METHODS A summary of COMPUS methods and results was followed by a review of assumptions (for trial-based glycosylated haemoglobin [HbA(1c)] effect, patient characteristics, costs, simulation pathway) and their potential impact. The UKPDS model was used for a 40-year cost-effectiveness analysis of SMBG (1.29 strips per day) versus no SMBG in the Canadian payer setting. COMPUS assumptions for patient characteristics (e.g. HbA(1c) 8.4%), SMBG HbA(1c) advantage (-0.25%) and costs were retained. As with the COMPUS analysis, UKPDS HbA(1c) decay curves were incorporated into SMBG and no-SMBG pathways. An important difference was that SMBG HbA(1c) benefits in the current study could extend beyond the initial simulation period. Sensitivity analyses examined SMBG HbA(1c) advantage, adherence, complication history and cost inputs. Outcomes (discounted at 5%) included QALYs, complication rates, total costs (year 2008 values) and incremental cost-effectiveness ratios (ICERs). RESULTS The base-case ICER was $Can63 664 per QALY gained; approximately 56% of the COMPUS base-case ICER. SMBG was associated with modest risk reductions (0.10-0.70%) for six of seven complications. Assuming an SMBG advantage of -0.30% decreased the current base-case ICER by over $Can10 000 per QALY gained. With adherence of 66% and 87%, ICERs were (respectively) $Can39 231 and $Can54 349 per QALY gained. Incorporating a more representative complication history and 15% complication cost increase resulted in an ICER of $Can49 743 per QALY gained. CONCLUSIONS These results underscore the importance of modelling assumptions regarding the duration of HbA(1c) effect. The current study shares several COMPUS limitations relating to the UKPDS model being designed for newly diagnosed patients, and to randomized controlled trial monitoring rates. Neither study explicitly examined the impact of varying the duration of initial HbA(1c) effects, or of medication or other treatment changes. Because the COMPUS research will potentially influence clinical practice and reimbursement policy in Canada, understanding the impact of assumptions on cost-effectiveness results seems especially important. Demonstrating that COMPUS ICERs were greatly reduced through variations in a small number of inputs may encourage additional clinical research designed to measure SMBG effects within the context of optimal disease management. It may also encourage additional economic evaluations that incorporate lessons learned and best practices for assessing the overall value of SMBG for type 2 diabetes in insulin-naive patients.
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Affiliation(s)
- Sandra L Tunis
- Independent Health Economics Research Consultant, Indianapolis, IN, USA
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Lu J, Bu RF, Sun ZL, Lu QS, Jin H, Wang Y, Wang SH, Li L, Xie ZL, Yang BQ. Comparable efficacy of self-monitoring of quantitative urine glucose with self-monitoring of blood glucose on glycaemic control in non-insulin-treated type 2 diabetes. Diabetes Res Clin Pract 2011; 93:179-186. [PMID: 21570146 DOI: 10.1016/j.diabres.2011.04.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 04/10/2011] [Accepted: 04/12/2011] [Indexed: 12/01/2022]
Abstract
AIM To assess whether self-monitoring of quantitative urine glucose or blood glucose is effective, convenient and safe for glycaemic control in non-insulin treated type 2 diabetes. METHODS Adults with non-insulin treated type 2 diabetes were recruited and randomized into three groups: Group A, self-monitoring with a quantitative urine glucose meter (n = 38); Group B, self monitoring with a blood glucose meter (n=35); Group C, the control group without self monitoring (n=35). All patients were followed up for six months, during which identical diabetes care was provided. RESULTS There was a significant decrease in HbA1c within each group (p < 0.05). At the study conclusion, mean changes in HbA1c from baseline were -1.9% for Group A, -1.5% for Group B and -1.0% for Group C, and the proportion of patients achieving HbA1c ≤ 6.5% were 38.9%, 35.3% and 20.0% respectively. However, no significant differences between the groups were found. The average monitoring frequency was significantly higher in Group A than in Group B. The incidence of hypoglycaemia and quality of life scores were similar between the groups. CONCLUSIONS This study suggests that self-monitoring of urine glucose has comparable efficacy on glycaemic control, and facilitates better compliance than blood self monitoring, without influencing the quality of life or risk of hypoglycaemia.
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Affiliation(s)
- J Lu
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - R F Bu
- Department of Endocrinology and Metabolism, Wuxi People's Hospital, Wuxi, China
| | - Z L Sun
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, China.
| | - Q S Lu
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - H Jin
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Y Wang
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - S H Wang
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - L Li
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Z L Xie
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - B Q Yang
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Stetson B, Schlundt D, Peyrot M, Ciechanowski P, Austin MM, Young-Hyman D, McKoy J, Hall M, Dorsey R, Fitzner K, Quintana M, Narva A, Urbanski P, Homko C, Sherr D. Monitoring in diabetes self-management: issues and recommendations for improvement. Popul Health Manag 2011; 14:189-97. [PMID: 21323462 DOI: 10.1089/pop.2010.0030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The American Association of Diabetes Educators hosted a Monitoring Symposium during which 18 invited participants considered pre-set questions regarding how diabetes education can more effectively address barriers to monitoring for people with diabetes and related conditions. This report provides a summary of the moderated discussion and highlights the key points that apply to diabetes educators and other providers involved with diabetes care. The participating thought leaders reviewed findings from published literature and participated in a moderated discussion with the aim of providing practical advice for health care practitioners regarding monitoring for people with diabetes so that the overall health of this population can be enhanced. The discussants also defined monitoring for diabetes as including that done by the clinician or laboratory, as well as self-monitoring. The discussion was distilled into key points that apply to diabetes educators and other providers involved with diabetes care. Participants developed specific recommendations for a self-monitoring behavior and monitoring framework. People with diabetes benefit from instruction and guidance about self-monitoring and decision making that is based on monitored results and informed interactions with providers. Importantly, collaboration among the entire diabetes care community is needed to ensure that monitoring is performed and utilized to its fullest advantage. Going forward, it will be critical to mitigate barriers to diabetes self-management and training and to identify linkages and partnerships to address barriers to self-monitoring.
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Affiliation(s)
- Barbara Stetson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky 40208, USA.
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Morgan CL, Griffin A, Chamberlain GH, Turkiendorf A, McEwan P, Evans LM, Owens DR. A longitudinal study into the new and long-term use of self-monitoring blood glucose strips in the UK. Diabetes Ther 2010; 1:1-9. [PMID: 22127668 PMCID: PMC3118273 DOI: 10.1007/s13300-010-0001-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2010] [Indexed: 11/28/2022] Open
Abstract
AIMS To determine the impact of self-monitoring blood glucose (SMBG) strip use in patients with type 2 diabetes in the UK. METHODS The study period was April 1, 2004 to July 31, 2005. Data from primary care was extracted from The Health Improvement Network database. Patients identified with diabetes and matching the inclusion criteria were defined as new users of SMBG, prevalent users, or non-users. Patients were also defined as treated with insulin, with oral agents (OA), or not pharmacologically treated. Change in glycosylated hemoglobin (HbA(1c)) at baseline and after 12 months was compared. RESULTS 2559 patients met the inclusion criteria. For new users, HbA(1c) fell by 0.59% (P=0.399) for those treated with insulin, 1.52% (P<0.001) for those treated with OA, and 0.51% (P<0.001) for no treatment. In prevalent users, changes were 0.31% (P<0.001), 0.34% (P<0.001), and 0.09% (P=0.456), respectively. In non-users, changes were 0.28% (P=0.618), 0.42% (P<0.001), and an increase of 0.05% (P=0.043), respectively. A significant decrease in mean HbA(1c) was associated with increasing strip use in OA patients newly initiated on strips. CONCLUSION This observational study showed a significant decrease in HbA(1c) for new users of SMBG treated either non-pharmacologically or with OA, and for prevalent users treated with insulin or OA. Reduced HbA(1c) with increasing strip use was observed but was only significant for OA-treated new users. This suggests that SMBG use has a role in the treatment of non-insulin treated patients with type 2 diabetes.
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Affiliation(s)
- C L Morgan
- Cardiff Research Consortium, Cardiff, Medicentre, Cardiff, CF14 4UJ, UK,
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12
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Kolb H, Kempf K, Martin S, Stumvoll M, Landgraf R. On what evidence-base do we recommend self-monitoring of blood glucose? Diabetes Res Clin Pract 2010; 87:150-6. [PMID: 19926160 DOI: 10.1016/j.diabres.2009.10.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 10/14/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
Abstract
Self-monitoring of blood glucose (SMBG) has been considered one major breakthrough in diabetes therapy because, for the first time, patients were able to determine their blood glucose levels during daily life. It seems obvious that this must be of advantage to disease management and clinical outcome, but it has become a nightmare for those trying to provide evidence. Randomised controlled trials have yielded inconsistent results on a benefit of SMBG-based treatment strategies not only in type 2 but - surprisingly - also in type 1 and gestational diabetes. Despite this, SMBG is being considered indispensible in intensive insulin treatment, but is being debated for other clinical settings. When considering the non-RCT based reasons for recommending SMBG in type 1 and gestational diabetes it becomes apparent that the same reasons also apply to type 2 diabetes.
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Affiliation(s)
- Hubert Kolb
- Hagedorn Research Institute, DK Gentofte, Denmark.
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13
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Kolb H, Martin S, Lodwig V, Heinemann L, Scherbaum WA, Schneider B. Are type 2 diabetes patients who self-monitor blood glucose special? The role of confounders in the observational ROSSO study. J Diabetes Sci Technol 2009; 3:1507-15. [PMID: 20144407 PMCID: PMC2787053 DOI: 10.1177/193229680900300633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the German multicenter, retrospective cohort study (ROSSO), those patients with type 2 diabetes who performed self-monitoring of blood glucose (SMBG) had a better long-term clinical outcome. We analyzed whether confounders accounted for the lower rate of clinical events in the SMBG cohort. METHODS ROSSO followed 3268 persons from diagnosis of type 2 diabetes for a mean of 6.5 years. Data were retrieved from patient files of randomly contacted primary care practices. RESULTS In total, more than 60 potential confounders were documented, including nondisease-associated parameters such as patient's health insurance, marital status, habitation, and characteristics of diabetes centers. There were only modest differences for these parameters between groups with versus without SMBG, and multiple adjustments did not weaken the association of SMBG use with better outcome (odds ratio 0.65, 95% confidence interval 0.53-0.81, p < .001). This was also true for subgroups of patients defined by type of antidiabetes treatment. Propensity score analysis confirmed the association of SMBG use with outcome. Using key baseline parameters, 813 matching pairs of patients were identified. The analysis again showed a better long-term outcome in the SMBG group (hazard ratio 0.67 p = .004). CONCLUSION An influence of nonrecognized confounders on better outcome in the SMBG group is rendered improbable by similar results obtained with adjustments for disease-associated or disease-independent parameters, by the analysis of patient subgroups, by propensity score analysis and by performing a matched-pair analysis. The higher flexibility in pharmacological antidiabetes treatment regimens in the SMBG cohort suggests a different attitude of treating physicians and patients in association with SMBG.
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Affiliation(s)
- Hubert Kolb
- Hagedorn Research Institute, Gentofte, Denmark.
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14
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Parkin CG, Hinnen D, Campbell RK, Geil P, Tetrick DL, Polonsky WH. Effective use of paired testing in type 2 diabetes: practical applications in clinical practice. DIABETES EDUCATOR 2009; 35:915-27. [PMID: 19789359 DOI: 10.1177/0145721709347601] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE The purpose of this article is to discuss practical approaches to the use of self-monitoring of blood glucose (SMBG) in clinical practice using paired glucose testing. A rationale for SMBG use and innovative tools for data collection and analysis are presented. Method Health care professionals from various medical specialties collaborated to review current evidence regarding the value and utility of SMBG and to formulate professional opinions regarding use of SMBG. The literature review included key SMBG studies from 2002 through 2009. Established guidelines, position papers, and other evidence were also reviewed for this report. Reference Manager Software was used to search ISI Web of Science, PubMed, and Z39.50 site databases. RESULTS Although the utility of SMBG in non-insulin-treated type 2 diabetes remains controversial, a recent report from the International Diabetes Federation recommends SMBG use in this population if it is used to educate/motivate individuals and/or monitor and adjust therapy. Health care providers must develop strategies to use SMBG in ways that address these criteria. CONCLUSIONS Paired SMBG (testing before/after specific events) promotes diabetes knowledge and self-management skills and facilitates assessment of the impact of behavioral changes, medical nutrition therapy, and pharmacologic interventions on glycemic levels. New tools have been developed to assist in using paired testing in clinical practice.
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Affiliation(s)
| | - Deborah Hinnen
- Mid America Diabetes Associates, Wichita, Kansas (Ms Hinnen)
| | - R Keith Campbell
- College of Pharmacy, Washington State University, Pullman, Washington (Mr Campbell)
| | - Patricia Geil
- Geil Nutrition Communications, Lexington, Kentucky (Ms Geil)
| | - David L Tetrick
- Internal Medicine Associates of Indianapolis, Indianapolis, Indiana (Dr Tetrick)
| | - William H Polonsky
- University of Southern California San Diego, Behavioral Diabetes Institute, San Diego, California (Dr Polonsky)
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15
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Chang A, Orth A, Le B, Menchavez P, Miller L. Performance analysis of the OneTouch UltraVue blood glucose monitoring system. J Diabetes Sci Technol 2009; 3:1158-65. [PMID: 20144431 PMCID: PMC2769918 DOI: 10.1177/193229680900300521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND OneTouch UltraVue is a new meter for self-monitoring of blood glucose that includes a color display, used-strip ejector, and no-button interface. The system uses an electrochemical biosensor technology based on glucose oxidase chemistry to detect glucose concentrations from 20 to 600 mg/dl (1.1 to 33.3 mmol/liter). METHODS Accuracy and reproducibility were evaluated over a wide range of glucose concentrations according to standard criteria. Clinical accuracy was assessed by health care providers (HCPs) in two studies and by diabetes patients in the second study. Reference glucose levels were determined by a YSI 2300 analyzer. Same-day reproducibility and day-to-day reproducibility were also evaluated. RESULTS In the accuracy studies, 99.7% and 98.7% of tests by HCPs and 97.0% of tests by patients were within +/-15 mg/dl (+/-0.8 mmol/liter) of the YSI reference for blood glucose <75 mg/dl (<4.2 mmol/liter), and within +/-20% for blood glucose > or =75 mg/dl (> or =4.2 mmol/liter), respectively. Consensus error grid analysis showed that 99.7% and 95.3% of tests by HCPs and 97.0% of tests by patients fell within zone A (i.e., has no effect on clinical action); all other results were in zone B (i.e., altered clinical action, little or no effect on clinical outcome). In the reproducibility studies, the standard deviation was <1.5 mg/dl (<0.1 mmol/liter) for glucose concentrations <100 mg/dl (<5.6 mmol/liter), and the coefficient of variation was <2% for concentrations > or = 100 mg/dl (> or =5.6 mmol/liter). CONCLUSIONS OneTouch UltraVue meets standard acceptability criteria for accuracy and reproducibility across a wide range of glucose concentrations. Its simple interface and lack of contact with used strips make it a viable option for older patients and their caregivers.
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Affiliation(s)
- Anna Chang
- John Muir Physician Network Clinical Research Center, Concord, California 94520, USA.
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16
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Fabiato K, Buse J, Duclos M, Largay J, Izlar C, O'Connell T, Stallings J, Dungan K. Clinical experience with continuous glucose monitoring in adults. Diabetes Technol Ther 2009; 11 Suppl 1:S93-S103. [PMID: 19469683 DOI: 10.1089/dia.2009.0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite recent advances in therapy, achieving adequate glycemic control may be difficult for a large number of patients with diabetes. Real-time (RT)-continuous glucose monitoring (CGM) has the potential to improve glycemic control through immediate feedback to the properly trained patient. However, limitations exist both in interpreting the results of published randomized clinical trials on CGM use and in extrapolating the results to the diabetes population at large. This review summarizes the evidence for use, identifies suitable candidates, describes optimal implementation, and employs case scenarios in order to emphasize practical aspects of RT-CGM use in adults. Establishment of expectations and comprehensive education in intensive insulin therapy and RT-CGM use are necessary for successful implementation. Because the technology has been shown to be most useful in patients who are actively viewing and responding to RT data, patients should receive explicit instructions for active self-adjustment of insulin and lifestyle elements. While the technology is improving, false alarms remain a significant barrier to optimal use. The utility of RT-CGM for patients with severe hypoglycemia or hypoglycemia unawareness has not been established. Finally, studies are needed to determine the sustainability of improvements in glycemic control, as well as cost-effectiveness and practicality of implementation into busy real-world practice.
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Affiliation(s)
- Kristin Fabiato
- UNC Highgate Diabetes and Endocrinology Clinic, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 25799, USA
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17
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Malanda UL, Bot SDM, Kostense PJ, Snoek FJ, Dekker JM, Nijpels G. Effects of self-monitoring of glucose in non-insulin treated patients with type 2 diabetes: design of the IN CONTROL-trial. BMC FAMILY PRACTICE 2009; 10:26. [PMID: 19397795 PMCID: PMC2679708 DOI: 10.1186/1471-2296-10-26] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 04/27/2009] [Indexed: 11/10/2022]
Abstract
Background Diabetes specific emotional problems interfere with the demanding daily management of living with type 2 diabetes mellitus (T2DM). Possibly, offering direct feedback on diabetes management may diminish the presence of diabetes specific emotional problems and might enhance the patients' belief they are able to manage their illness. It is hypothesized that self-monitoring of glucose in combination with an algorithm how and when to act will motivate T2DM patients to become more active participants in their own care leading to a decrease in diabetes related distress and an increased self-efficacy. Methods and design Six hundred patients with T2DM (45 ≤ 75 years) who receive care in a structured diabetes care system, HbA1c ≥ 7.0%, and not using insulin will be recruited and randomized into 3 groups; Self-monitoring of Blood Glucose (SMBG), Self-monitoring of Urine Glucose (SMUG) and usual care (n = 200 per group). Participants are eligible if they have a known disease duration of over 1 year and have used SMBG or SMUG less than 3 times in the previous year. All 3 groups will receive standardized diabetes care. The intervention groups will receive additional instructions on how to perform self-monitoring of glucose and how to interpret the results. Main outcome measures are changes in diabetes specific emotional distress and self-efficacy. Secondary outcome measures include difference in HbA1c, patient satisfaction, occurrence of hypoglycaemia, physical activity, costs of direct and indirect healthcare and changes in illness beliefs. Discussion The IN CONTROL-trial is designed to explore whether feedback from self-monitoring of glucose in T2DM patients who do not require insulin can affect diabetes specific emotional distress and increase self-efficacy. Based on the self-regulation model it is hypothesized that glucose self-monitoring feedback changes illness perceptions, guiding the patient to reduce emotional responses to experienced threats, and influences the patients ability to perform and maintain self-management skills. Trial registration Current Controlled Trials ISRCTN84568563
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Affiliation(s)
- Uriëll L Malanda
- EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
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18
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Montagnana M, Caputo M, Giavarina D, Lippi G. Overview on self-monitoring of blood glucose. Clin Chim Acta 2009; 402:7-13. [PMID: 19167374 DOI: 10.1016/j.cca.2009.01.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 01/02/2009] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
Abstract
The self-monitoring of blood glucose (SMBG), traditionally performed by "point-of-care" (POC) devices called portable glucose monitors (PGM) is now considered an integral part of managed care of diabetic patients, especially type 1 diabetics and those on insulin therapy. In patients with type 2 diabetes, SMBG can help to achieve a better glycaemic control, although there is not sufficient evidence to attest that strict monitoring in these patients is associated with an improved outcome. The outcome of several clinical studies, especially in diabetics on insulin therapy, has shown that SMBG plays a key role in preventing complications in the short, medium and long term. According to the current recommendations, SMBG is aimed to achieve and maintain glycaemic control, prevent and identify hypoglycaemia, prevent severe hyperglycaemia, adjust lifestyle changes and establish the need to begin treatment with insulin in gestational diabetes mellitus. However, as clearly highlighted by the American Diabetes Association (ADA) and the National Academy of Clinical Biochemistry (NACB), patients and healthcare personnel should be trained on the appropriate use of the device, as well as on the correct interpretation of data. Moreover, definite analytical targets and appropriate acceptance criteria for performance should be fulfilled before a new device is introduced in the hospital environment, or recommended to the patients. Performance limitations such as hematocrit extremes and analytical interferences should be clearly acknowledged by the operators, before taking test results for granted. The current article aims to review the current indications for SMGB and highlight the most important criteria for the appropriate use of PGMs.
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Affiliation(s)
- Martina Montagnana
- Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università di Verona, Italy
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Hirsch IB, Bode BW, Childs BP, Close KL, Fisher WA, Gavin JR, Ginsberg BH, Raine CH, Verderese CA. Self-Monitoring of Blood Glucose (SMBG) in insulin- and non-insulin-using adults with diabetes: consensus recommendations for improving SMBG accuracy, utilization, and research. Diabetes Technol Ther 2008; 10:419-39. [PMID: 18937550 DOI: 10.1089/dia.2008.0104] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Current clinical guidelines for diabetes care encourage self-monitoring of blood glucose (SMBG) to improve glycemic control. Specific protocols remain variable, however, particularly among non-insulin-using patients. This is due in part to efficacy studies that neglect to consider (1) the performance of monitoring equipment under real-world conditions, (2) whether or how patients have been taught to take action on test results, and (3) the physiological, behavioral, and social circumstances in which SMBG is carried out. As such, a multidisciplinary group of specialists, including several endocrinologists, a health psychologist, a diabetes nurse practitioner, and a patient advocate (the Panel), discuss within this review article how the potential of SMBG might be fully realized in today's healthcare environment. The resulting recommendations cover technological, clinical, behavioral, and research considerations with the aim of achieving short- and long-term benefits, ranging from fewer hypoglycemic episodes to lower complication-related costs. The panel also made suggestions for designing future studies that increase the ability to discern optimal models of SMBG utilization for individuals with diabetes who may, or may not, use insulin.
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Affiliation(s)
- Irl B Hirsch
- Department of Medicine, University of Washington Medical Center-Roosevelt, Seattle, Washington 98105, USA.
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20
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Klonoff DC, Bergenstal R, Blonde L, Boren SA, Church TS, Gaffaney J, Jovanovic L, Kendall DM, Kollman C, Kovatchev BP, Leippert C, Owens DR, Polonsky WH, Reach G, Renard E, Riddell MC, Rubin RR, Schnell O, Siminiero LM, Vigersky RA, Wilson DM, Wollitzer AO. Consensus report of the coalition for clinical research-self-monitoring of blood glucose. J Diabetes Sci Technol 2008; 2:1030-53. [PMID: 19885292 PMCID: PMC2769823 DOI: 10.1177/193229680800200612] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Coalition for Clinical Research-Self-Monitoring of Blood Glucose Scientific Board, a group of nine academic clinicians and scientists from the United States and Europe, convened in San Francisco, California, on June 11-12, 2008, to discuss the appropriate uses of self-monitoring of blood glucose (SMBG) and the measures necessary to accurately assess the potential benefit of this practice in noninsulin-treated type 2 diabetes mellitus (T2DM). Thirteen consultants from the United States, Europe, and Canada from academia, practice, and government also participated and contributed based on their fields of expertise. These experts represent a range of disciplines that include adult endocrinology, pediatric endocrinology, health education, mathematics, statistics, psychology, nutrition, exercise physiology, and nursing. This coalition was organized by Diabetes Technology Management, Inc. Among the participants, there was consensus that: protocols assessing the performance of SMBG in noninsulin treated T2DM must provide the SMBG intervention subjects with blood glucose (BG) goals and instructions on how to respond to BG data in randomized controlled trials (RCTs);intervention subjects in clinical trials of SMBG-driven interventions must aggressively titrate their therapeutic responses or lifestyle changes in response to hyperglycemia;control subjects in clinical trials of SMBG must be isolated from SMBG-driven interventions and not be contaminated by physician experience with study subjects receiving a SMBG intervention;the best endpoints to measure in a clinical trial of SMBG in T2DM include delta Hemoglobin A1c levels, hyperglycemic events, hypoglycemic events, time to titrate noninsulin therapy to a maximum necessary dosage, and quality of life indices;either individual randomization or cluster randomization may be appropriate methods for separating control subjects from SMBG intervention subjects, provided that precautions are taken to avoid bias and that the sample size is adequate;treatment algorithms for assessing SMBG in T2DM may include a dietary, exercise, and/or medication intervention, which are all titratable according to the SMBG values;the medical literature contains very little information about the performance of SMBG in T2DM from RCTs in which treatment algorithms were used for dysglycemic values; and research on the performance of SMBG in T2DM based on sound scientific principles and clinical practices is needed at this time.
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Affiliation(s)
- David C Klonoff
- Mills-Peninsula Health Services, San Mateo, California 94401, USA.
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Abstract
Self-monitoring of blood glucose (SMBG) by means of modern glucose meters is of relevance for all patients with diabetes. It not only provides important information about the effect of therapeutic interventions on metabolic control, but about the effect of exercise and meals as well. Therefore, it is an essential part of diabetes therapy. However, it has received little interest from academia in the last 10 years. This is in sharp contrast to the massive increase in SMBG use in the last decades and its economic impact on health care systems. Many physicians and patients believe that SMBG and the measurement technologies behind it are a no-brainer nowadays, i.e., that the measurement provides reliable results in practically all cases. In reality, it appears as if patients have only mediocre knowledge about the appropriate handling of the procedure and subsequent therapeutic action. Also, evaluation of the measurement quality of blood glucose meters is not studied adequately in many cases. Such studies should also take into account handling by the patients themselves under daily life conditions. Unfortunately, most of such studies are initiated and sponsored by the manufacturers of blood glucose meters/test strips, and not by an independent institution. In view of the costs and risks combined with SMBG, we should consider that all patients participate in a course that ends with a little examination and provides them with a "driver's license" for this diagnostic measure.
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Affiliation(s)
- Lutz Heinemann
- Profil Institute for Metabolic Research, Neuss, Germany.
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