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SMBG beneficial for adults with type 2 diabetes
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SAN DIEGO — Adults with poorly controlled type 2 diabetes who were not taking insulin were able to reduce their HbA1c with a structured program of self-monitoring blood glucose levels, according to a speaker here.
David R. Owens, MD, FRCP, chair of the Swansea University Medical School, U.K., and colleagues randomly assigned 447 adults aged 27 to 80 years (mean age, 61.7 years; 259 men; 60% with diabetes for at least 5 years; 19% with diabetes complications) to one of three treatment groups for 12 months: usual care (controls); structured SMBG with clinical review every 3 months; and the SMBG program plus monthly telehealth support. Patients and health care providers were recruited from 14 health centers in Wales and two in England. All diabetes management in the study groups was based on glucose results, with HbA1c at 12 months as the primary outcome; HbA1c measures obtained during the study were not shared with participants or health care providers. Providers received standardized nursing and e-health training, had accreditation certification and were instructed in glucose profiles and treatment algorithms.
Mean HbA1c at baseline was 8.6% and did not differ among groups; patient groups had similar demographics. All participants had basic diabetes education at the beginning of the study. The usual care group did not use routine SMBG; these patients reviewed the basic education every 3 months, and there was no goal-setting with the provider. The SMBG groups had additional education, including the technical aspects of blood glucose testing and how to interpret their profile; clinical data were collected at visits every 3 months, including 7-point profiles for 3 days before their first 3-month visit. The telehealth group additionally had monthly phone conversations with the provider to discuss the prior 3 days of SMBG data. HbA1c was measured at the final visit at 12 months. Researchers also collected health-related data, patient-reported outcome measures and safety data.
Both SMBG groups experienced an early and sustained reduction in HbA1c, according to Owens. At 12 months, mean HbA1c was 8.3% (P < .01) in the usual care group, 7.4% (P < .001) in the SMBG group and 7.3% (P < .001) in the telehealth group.
“We found that, therefore, SMBG for most people can be performed successfully by trained nurses and informed patients who are willing perform blood glucose monitoring,” Owens said during the presentation. “We have further analysis to be done in order to find who benefits, what sort of benefits and why.” – by Jill Rollet
Editor’s Note: On June 13, 2017, this article was updated to correct the location of Swansea University Medical School. The Editors regret this error.
Reference:
Parsons SN, et al. 61-OR. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.
Disclosures: The researchers report no relevant financial disclosures.