NEW YORK (Reuters Health) Nov 29 - A self-monitoring program built around mealtime blood glucose measurements helps improve glycemic control in most non-insulin treated type 2 diabetic patients, German researchers report in the November issue of Diabetes Care.

Dr. Ulrich Schwedes of General Hospital Barmbek, Hamburg, and colleagues note that "monitoring blood glucose status is an important tool in diabetes treatment procedures." To investigate whether a structured approach to such monitoring might be helpful, the researchers conducted a study of more than 200 non-insulin treated type 2 diabetics.

They were randomized to a control or intervention group. Those in the intervention group used a blood glucose monitoring device before and after 3 main meals on 2 days a week, and kept a daily diary covering general well being, details of meals and blood glucose levels.

They also received standard counseling. The control group received nonstandard counseling on their diet and lifestyle.

At the end of the 6-month study, use of the glucose monitoring device led to a 1.0% reduction in hemoglobin a1c levels, significantly more than the 0.54% reduction seen in the control group. There was also a marked improvement in general well being.

Body weight, total cholesterol and microalbumin also showed improvements, but there were no significant between-group differences.

Overall, the researchers, who note that the intervention was well received and that there was a high rate of compliance, conclude that the approach can lead to a significant improvement in glycemic control.

Furthermore, Dr. Schwedes told Reuters Health that "knowledge of the actual value of blood glucose helps patients to handle their illness in a better way." This appears to be true, he pointed out, of "all patients with diabetes," not only those receiving insulin therapy.

Diabetes Care 2002;25:1928-1932.

Journal abstract, from Diabetes Care 2002

Meal-Related Structured Self-Monitoring of Blood Glucose
Effect on diabetes control in non-insulin-treated type 2 diabetic patients

Ulrich Schwedes, MD1, Markus Siebolds, MD2 and Gabriele Mertes, PHD3 For the SMBG Study Group
1 General Hospital Barmbek, Hamburg, Germany
2 Catholic University of Applied Sciences, Cologne, Germany
3 Bayer Vital, Leverkusen, Germany

OBJECTIVE—To investigate the effect of meal-related self-monitoring of blood glucose on glycemic control and well-being in non-insulin-treated type 2 diabetic patients.

RESEARCH DESIGN AND METHODS—This 6-month study, which included 6 months of follow-up, adopted a prospective, multicenter, randomized controlled design. Subjects were randomized to two groups: one group used a blood glucose-monitoring device, kept a blood glucose/eating diary, and received standardized counseling; the control group received nonstandardized counseling on diet and lifestyle. The primary efficacy parameter was the change in HbA1c. Secondary efficacy variables included changes in body weight, lipids, and microalbumin and changes in treatment satisfaction and well-being.

RESULTS—In the per-protocol analysis, the use of a self-monitoring blood glucose device significantly reduced HbA1c levels by 1.0 ± 1.08% compared with 0.54 ± 1.41% for the control group (P = 0.0086); subgroup analysis showed three types of responders. Body weight, total cholesterol, and microalbumin improved when using a glucometer, but there was no statistically significant difference between the two groups. Treatment satisfaction increased in both groups to a similar extent (P = 0.9). Self-monitoring resulted in a marked improvement of general well-being with significant improvements in the subitems depression (P = 0.032) and lack of well-being (P = 0.02).

CONCLUSIONS—Meal-related self-monitoring of blood glucose within a structured counseling program improved glycemic control in the majority of non-insulin-treated type 2 diabetic patients in this study. The finding of three types of responders will be important for future planning of counseling and educational interventions.


http://care.diabetesjournals.org/cg...ract/25/11/1928