The effects of structured self-monitoring of blood glucose on therapeutic effectiveness and adherence in patients with type 2 diabetes mellitus initiating insulin treatment

Abstract

Aim. To compare the efficiency of standard and structured approaches to self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes mellitus (T2DM) initiating insulin treatment. Materials and Methods. This open prospective randomized clinical trial included 51 T2DM patients who initiated insulin therapy in either outpatient or inpatient setting. Subjects were randomized in standard and structured SMBG groups, the structured group used an advanced Accu-Chek 360 View protocol. Evaluation included clinical examination and laboratory testing of HbA1c levels at the beginning of the treatment and after 3 months of the follow-up period. Results. 70% of the structured self-monitoring group and 32% of the control group achieved therapeutic goals (p=0.008). Higher adherence was associated with better glycemic control in both groups ? and vice versa. However, among patients with low adherence, 73% of advanced SMBG group managed to achieve therapeutic goals vs. 19% in the control group (p=0.005). In addition, patients in the structured monitoring group gained less weight as compared to the control (1.0?2.88 kg vs. 3.2?2.56 kg; p=0.005). Conclusion. Structured SMBG commenced at the initiation of insulin therapy improves glycemic control in a greater fraction of patients, especially in those with low adherence to treatment. Structured SMBG also partially alleviates weight gain as side effect of insulin treatment.

Keywords

• type 2 diabetes mellitus
• self-monitoring of blood glucose
• insulin initiation