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A structured self-monitoring of blood glucose approach in type 2 diabetes encourages more frequent, intensive, and effective physician interventions: results from the STeP study.
Diabetes Technol Ther. 2011 Aug; 13(8):797-802.DT

Abstract

BACKGROUND

We evaluated how a structured patient/physician self-monitoring of blood glucose (SMBG) intervention influenced the timing, frequency, and effectiveness of primary care physicians' treatment changes with type 2 diabetes mellitus (T2DM) patients over 12 months.

METHODS

The Structured Testing Program (STeP) study was a cluster-randomized, multicenter trial with 483 poorly controlled, insulin-naive T2DM subjects. Primary care practices were randomized to the Active Control Group (ACG) or the Structured Testing Group (STG), the latter of which included quarterly review of structured SMBG results. STG patients used a paper tool that graphs seven-point glucose profiles over 3 consecutive days; physicians received a treatment algorithm based on SMBG patterns. Impact of structured SMBG on physician treatment modification recommendations (TMRs) and glycemic outcomes was examined.

RESULTS

More STG than ACG patients received a TMR at each study visit (P < 0.0001). Of patients who received at least one TMR, STG patients demonstrated a greater reduction in glycated hemoglobin A1c (HbA1c) than ACG patients (-1.2% vs. -0.8%, P < 0.03). Patients with a baseline HbA1c ≥8.5% who received a TMR at the Month 1 visit experienced greater reductions in HbA1c (P = 0.002) than patients without an initial TMR. More STG than ACG patients were started on incretins (P < 0.01) and on thiazolidinediones (P = 0.004). The number of visits with a TMR was unrelated to HbA1c change over time.

CONCLUSIONS

Patient-provided SMBG data contribute to glycemic improvement when blood glucose patterns are easy to detect, and well-trained physicians take timely action. Collaborative use of structured SMBG data leads to earlier, more frequent, and more effective TMRs for poorly controlled, non-insulin-treated T2DM subjects.

Authors+Show Affiliations

University of California, San Diego, and Behavioral Diabetes Institute, San Diego, California, USA.No 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)

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

Language

eng

PubMed ID

21568751

Citation

Polonsky, William H., et al. "A Structured Self-monitoring of Blood Glucose Approach in Type 2 Diabetes Encourages More Frequent, Intensive, and Effective Physician Interventions: Results From the STeP Study." Diabetes Technology & Therapeutics, vol. 13, no. 8, 2011, pp. 797-802.
Polonsky WH, Fisher L, Schikman CH, et al. A structured self-monitoring of blood glucose approach in type 2 diabetes encourages more frequent, intensive, and effective physician interventions: results from the STeP study. Diabetes Technol Ther. 2011;13(8):797-802.
Polonsky, W. H., Fisher, L., Schikman, C. H., Hinnen, D. A., Parkin, C. G., Jelsovsky, Z., Axel-Schweitzer, M., Petersen, B., & Wagner, R. S. (2011). A structured self-monitoring of blood glucose approach in type 2 diabetes encourages more frequent, intensive, and effective physician interventions: results from the STeP study. Diabetes Technology & Therapeutics, 13(8), 797-802. https://doi.org/10.1089/dia.2011.0073
Polonsky WH, et al. A Structured Self-monitoring of Blood Glucose Approach in Type 2 Diabetes Encourages More Frequent, Intensive, and Effective Physician Interventions: Results From the STeP Study. Diabetes Technol Ther. 2011;13(8):797-802. PubMed PMID: 21568751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A structured self-monitoring of blood glucose approach in type 2 diabetes encourages more frequent, intensive, and effective physician interventions: results from the STeP study. AU - Polonsky,William H, AU - Fisher,Lawrence, AU - Schikman,Charles H, AU - Hinnen,Deborah A, AU - Parkin,Christopher G, AU - Jelsovsky,Zhihong, AU - Axel-Schweitzer,Matthias, AU - Petersen,Bettina, AU - Wagner,Robin S, Y1 - 2011/05/13/ PY - 2011/5/17/entrez PY - 2011/5/17/pubmed PY - 2011/12/16/medline SP - 797 EP - 802 JF - Diabetes technology & therapeutics JO - Diabetes Technol Ther VL - 13 IS - 8 N2 - BACKGROUND: We evaluated how a structured patient/physician self-monitoring of blood glucose (SMBG) intervention influenced the timing, frequency, and effectiveness of primary care physicians' treatment changes with type 2 diabetes mellitus (T2DM) patients over 12 months. METHODS: The Structured Testing Program (STeP) study was a cluster-randomized, multicenter trial with 483 poorly controlled, insulin-naive T2DM subjects. Primary care practices were randomized to the Active Control Group (ACG) or the Structured Testing Group (STG), the latter of which included quarterly review of structured SMBG results. STG patients used a paper tool that graphs seven-point glucose profiles over 3 consecutive days; physicians received a treatment algorithm based on SMBG patterns. Impact of structured SMBG on physician treatment modification recommendations (TMRs) and glycemic outcomes was examined. RESULTS: More STG than ACG patients received a TMR at each study visit (P < 0.0001). Of patients who received at least one TMR, STG patients demonstrated a greater reduction in glycated hemoglobin A1c (HbA1c) than ACG patients (-1.2% vs. -0.8%, P < 0.03). Patients with a baseline HbA1c ≥8.5% who received a TMR at the Month 1 visit experienced greater reductions in HbA1c (P = 0.002) than patients without an initial TMR. More STG than ACG patients were started on incretins (P < 0.01) and on thiazolidinediones (P = 0.004). The number of visits with a TMR was unrelated to HbA1c change over time. CONCLUSIONS: Patient-provided SMBG data contribute to glycemic improvement when blood glucose patterns are easy to detect, and well-trained physicians take timely action. Collaborative use of structured SMBG data leads to earlier, more frequent, and more effective TMRs for poorly controlled, non-insulin-treated T2DM subjects. SN - 1557-8593 UR - https://www.unboundmedicine.com/medline/citation/21568751/A_structured_self_monitoring_of_blood_glucose_approach_in_type_2_diabetes_encourages_more_frequent_intensive_and_effective_physician_interventions:_results_from_the_STeP_study_ L2 - https://www.liebertpub.com/doi/10.1089/dia.2011.0073?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -