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Can Self-Monitoring Blood Glucose Control Decrease Glycated Hemoglobin Levels in Diabetes Mellitus

Özmen, Bilgin M.D.*; Boyvada, Sibel M.D.†

CME Review Articles: CME Review Article #24
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The development and progression of diabetic complications is strongly related to the degree of glycemic control. To decrease the occurrence of these problems, instruments for self-monitoring of blood glucose (SMBG) control have been developed and have become widely used among diabetic patients. In this study, the authors determined the effect of SMBG control on glycated hemoglobin (HbA1c) levels in type 1 and type 2 diabetic patients.

Three hundred fifteen diabetic patients agreed to participate in this study and attended 8-hour training program that focused on what diabetes is, meal planning, physical activity, life behaviors, foot and dental care, complications, and infections of diabetes. Two hundred fifty-nine diabetic patients (21 with type 1 diabetes mellitus [DM] [group 1], 238 patients with type 2 DM [group 2]) all received glucometers and education on SMBG through an additional 2-hour training program. HbA1c levels were measured at baseline and at 6 and 12 months in all patients. The other 56 patients (all type 2 diabetic patients) did not use glucometers for SMBG control and were considered our control group (group 3).

Thirteen of the 21 patients with type 1 diabetes used an intensive insulin protocol and eight used a continuous subcutaneous insulin infusion pump (CSII). Overall, the HbA1c levels were slightly lower at the 6- and 12-month checkups in the type 1 patients, but the decrease was not statistically significant (p = 0.23). However, the HbA1c levels in the CSII group were significantly lower at 12 months (p = 0.04).

Conventional insulin treatment was used in 65 of the 99 patients with type 2 diabetes (nonobese) whereas 34 were treated with a combination of insulin and acarbose. In both of these groups, the HbA1c levels were slightly diminished at 6 and 12 months, but these decreases were not statistically significant (p = 0.26).

Of the 80 obese (body mass index [BMI] >30 kg/m2) patients, 30 were treated with orlistat and metformin, 30 with sibutramine and metformin, and 20 with metformin only. The levels of HbA1c in the two multi-medication groups were not significantly different from those of the metformin-only group (p = 0.35).

The mean levels of HbA1c at the 6-and 12-month checkups in the control group patients did not change (p = 0.92).

Implementing a program of SMBG control in DM patients results in lower levels of HbA1c at 6 and 12 months in only some DM patient groups. This intervention was especially effective in patients using a continuous subcutaneous insulin infusion pump. However, in group 1 and group 2, the decrease of the level HbA1c was not statistically significant, and no decreases in the HbA1c levels were seen in the authors’ control group (education only). SMBG results in better glycemic control as reflected by lower HbA1c levels; however, cost-effectiveness studies and longer-term clinical studies should be performed to determine the effects of SMBG on glycemic control, morbidity, and mortality.

*Assistant Professor and Resident in Endocrinology and Specialist in Internal Medicine, Departments of Endocrinology and Internal Medicine, Division of Endocrinology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.

CHIEF EDITOR’S NOTE: This article is the 24th of 36 that will be published in 2002 for which a total of up to 36 Category 1 CME credits can be earned. Instructions for how credits can be earned appear after the Table of Contents.

DOI: 10.1097/01.ten.0000023156.99278.2f

Address correspondence to: Bilgin Özmen, M.D., Plevne Bulvar No. 14/9, Alsancak, Izmir, 35220 Turkey. Phone: 00-90-232-4640497; Fax: 00-90-232-3392144; E-mail: bilozmen@yahoo.com

The authors have disclosed that they have no significant relationships with or financial interests in any commercial company pertaining to this educational activity.

© 2002 Lippincott Williams & Wilkins, Inc.