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Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study.
Diabetes Care. 2011 Feb; 34(2):262-7.DC

Abstract

OBJECTIVE

To assess the effectiveness of structured blood glucose testing in poorly controlled, noninsulin-treated type 2 diabetes.

RESEARCH DESIGN AND METHODS

This 12-month, prospective, cluster-randomized, multicenter study recruited 483 poorly controlled (A1C ≥ 7.5%), insulin-naïve type 2 diabetic subjects from 34 primary care practices in the U.S. Practices were randomized to an active control group (ACG) with enhanced usual care or a structured testing group (STG) with enhanced usual care and at least quarterly use of structured self-monitoring of blood glucose (SMBG). STG patients and physicians were trained to use a paper tool to collect/interpret 7-point glucose profiles over 3 consecutive days. The primary end point was A1C level measured at 12 months.

RESULTS

The 12-month intent-to-treat analysis (ACG, n = 227; STG, n = 256) showed significantly greater reductions in mean (SE) A1C in the STG compared with the ACG: -1.2% (0.09) vs. -0.9% (0.10); Δ = -0.3%; P = 0.04. Per protocol analysis (ACG, n = 161; STG, n = 130) showed even greater mean (SE) A1C reductions in the STG compared with the ACG: -1.3% (0.11) vs. -0.8% (0.11); Δ = -0.5%; P < 0.003. Significantly more STG patients received a treatment change recommendation at the month 1 visit compared with ACG patients, regardless of the patient's initial baseline A1C level: 179 (75.5%) vs. 61 (28.0%); <0.0001. Both STG and ACG patients displayed significant (P < 0.0001) improvements in general well-being (GWB).

CONCLUSIONS

Appropriate use of structured SMBG significantly improves glycemic control and facilitates more timely/aggressive treatment changes in noninsulin-treated type 2 diabetes without decreasing GWB.

Authors+Show Affiliations

University of California, San Diego, San Diego, California, USA. cgparkin@aol.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21270183

Citation

Polonsky, William H., et al. "Structured Self-monitoring of Blood Glucose Significantly Reduces A1C Levels in Poorly Controlled, Noninsulin-treated Type 2 Diabetes: Results From the Structured Testing Program Study." Diabetes Care, vol. 34, no. 2, 2011, pp. 262-7.
Polonsky WH, Fisher L, Schikman CH, et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study. Diabetes Care. 2011;34(2):262-7.
Polonsky, W. H., Fisher, L., Schikman, C. H., Hinnen, D. A., Parkin, C. G., Jelsovsky, Z., Petersen, B., Schweitzer, M., & Wagner, R. S. (2011). Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study. Diabetes Care, 34(2), 262-7. https://doi.org/10.2337/dc10-1732
Polonsky WH, et al. Structured Self-monitoring of Blood Glucose Significantly Reduces A1C Levels in Poorly Controlled, Noninsulin-treated Type 2 Diabetes: Results From the Structured Testing Program Study. Diabetes Care. 2011;34(2):262-7. PubMed PMID: 21270183.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study. AU - Polonsky,William H, AU - Fisher,Lawrence, AU - Schikman,Charles H, AU - Hinnen,Deborah A, AU - Parkin,Christopher G, AU - Jelsovsky,Zhihong, AU - Petersen,Bettina, AU - Schweitzer,Matthias, AU - Wagner,Robin S, PY - 2011/1/29/entrez PY - 2011/1/29/pubmed PY - 2011/4/26/medline SP - 262 EP - 7 JF - Diabetes care JO - Diabetes Care VL - 34 IS - 2 N2 - OBJECTIVE: To assess the effectiveness of structured blood glucose testing in poorly controlled, noninsulin-treated type 2 diabetes. RESEARCH DESIGN AND METHODS: This 12-month, prospective, cluster-randomized, multicenter study recruited 483 poorly controlled (A1C ≥ 7.5%), insulin-naïve type 2 diabetic subjects from 34 primary care practices in the U.S. Practices were randomized to an active control group (ACG) with enhanced usual care or a structured testing group (STG) with enhanced usual care and at least quarterly use of structured self-monitoring of blood glucose (SMBG). STG patients and physicians were trained to use a paper tool to collect/interpret 7-point glucose profiles over 3 consecutive days. The primary end point was A1C level measured at 12 months. RESULTS: The 12-month intent-to-treat analysis (ACG, n = 227; STG, n = 256) showed significantly greater reductions in mean (SE) A1C in the STG compared with the ACG: -1.2% (0.09) vs. -0.9% (0.10); Δ = -0.3%; P = 0.04. Per protocol analysis (ACG, n = 161; STG, n = 130) showed even greater mean (SE) A1C reductions in the STG compared with the ACG: -1.3% (0.11) vs. -0.8% (0.11); Δ = -0.5%; P < 0.003. Significantly more STG patients received a treatment change recommendation at the month 1 visit compared with ACG patients, regardless of the patient's initial baseline A1C level: 179 (75.5%) vs. 61 (28.0%); <0.0001. Both STG and ACG patients displayed significant (P < 0.0001) improvements in general well-being (GWB). CONCLUSIONS: Appropriate use of structured SMBG significantly improves glycemic control and facilitates more timely/aggressive treatment changes in noninsulin-treated type 2 diabetes without decreasing GWB. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/21270183/Structured_self_monitoring_of_blood_glucose_significantly_reduces_A1C_levels_in_poorly_controlled_noninsulin_treated_type_2_diabetes:_results_from_the_Structured_Testing_Program_study_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=21270183 DB - PRIME DP - Unbound Medicine ER -