What is Self-Monitoring Blood Glucose?

Self-monitoring of blood glucose (SMBG) is believed to improve glycemic control and identify hypoglycemia in those with diabetes who use insulin. However, there is still debate about the benefits of SMBG in people with type 2 diabetes who are not on insulin therapy. Many studies and meta-analyses have been conducted on this topic, but there is still no consensus because of the varied intervention regimens and study populations. Currently, regulatory authorities suggested the limited use of SMBG to just testing for hypoglycemia, not as an integral part of self-management in people with non-insulin-treated Type 2 diabetes.

What is Telemedicine?

Telemedicine, a way to deliver health services using telecommunications, has been increasingly popular. Many studies have found that telemedicine can help people with diabetes manage their blood sugar levels better than usual care. How telemedicine is delivered using communication technologies and how interactive it is between the healthcare provider and the person with diabetes can affect how well it works.

How SMBG may Improve Glycemic Control on Type 2 Diabetics

We studied if using structured SMBG in a large group of people with Type 2 diabetes not on insulin therapy would improve HbA1c over 12 months, compared to a control group receiving usual care as per National Institute for Health and Care Excellence (NICE) guidelines. We also studied if the addition of a monthly telephone consultation with a trained TeleCare study nurse provided additional glycemic benefit.

The Study on Self-Monitoring Blood Glucose for Glycemic Control

We conducted a 12-month, multicenter, randomized controlled trial in people who have been diagnosed with Type 2 diabetes for at least one year but not on insulin therapy. A total of 323 completed this study, where 116 were allocated to a control group who would receive the usual diabetes care; 99 were in a group who would use structured SMBG alone; 108 used structured SMBG with additional monthly TeleCare support.

Three monthly visits were held at three, six, and nine months from the start of the study. Participants provided clinical data and had their blood tested to measure glycated hemoglobin (HbA1c) and total cholesterol levels. They also reviewed their diary, in which they recorded significant events, medication changes, and contact with healthcare professionals.

Those in the SMBG groups (groups 2 and 3) attended an additional study visit to undertake structured SMBG training to know when and how to correctly take, measure their BG, and record the readings on a paper tool called the Accu-Chek 360° View Tool. They were also shown how to interpret their SMBG results and how any abnormality would be corrected. All actions taken in response to the BG monitoring were recorded.

Those in group 3 were contacted by telephone at an agreed time each month to review the previous months’ BG readings. At each consultation, the participant and study nurse would discuss recorded abnormalities, a care plan formed and documented by the participant in his diary.

The Results

The mean HbA1c was lower in all groups at 12 months compared to baseline. The reduction was greater in the combined SMBG group compared to the control group. However, there was no significant difference in HbA1c reduction at 12 months between the two SMBG groups.

Importantly, participants in the structured SMBG group were three times more likely to reach the HbA1c target of less than or equal to 53 millimoles per mole than those in the control group. Participants with lower baseline HbA1c, shorter duration of diabetes, and higher educational achievement were more likely to achieve the HbA1c target.

The Conclusion

Structured self-monitoring of blood glucose provides clinical and statistical improvements in glycemic control in people with Type 2 diabetes; therefore, it should be made available as part of their self-management process, including those not on insulin therapy.

Reference

Effect of Structured Self-Monitoring of Blood Glucose (SMBG), With and Without Additional TeleCare Support, on Overall Glycemic Control in Non-Insulin Treated Type 2 Diabetes: The SMBG Study, a 12-month Randomized Controlled Trial