Background: Structured self-monitoring of blood glucose (SMBG) involves gathering blood glucose data to a defined regimen (e.g. 3-day, 7-point profiles), interpreting and then using those data to make appropriate pharmacologic and/or lifestyle adjustments. The benefits of ‘structured SMBG’ have been demonstrated in US/European studies but generalizability has not yet been demonstrated in Australia.
Methods: The Structured Testing Program Implementation Trial (STeP IT UP) assessed the impact of ‘structured SMBG’ on HbA1c and diabetes-related distress (DDS) in 98 adults with non-insulin treated type 2 diabetes, with suboptimal HbA1c (>7.5%) at baseline and managed in primary care settings across Australia: 38% women, mean [SD] age 62 years, BMI 31.7[6.3] kg/m2, HbA1c 8.6[1.1]%. In this 24-week, multi-centre, observational study, primary care clinicians with ‘structured SMBG’ experience trained participants to use and interpret the Accu-Chek 360° View paper tool. Participants completed the tool prior to their visits at weeks 4, 12 and 24; results were discussed at each visit.
Results: 98 participants had HbA1c measurements available at screening and weeks 12 and 24. Reductions in HbA1c from week 4 were seen at weeks 12 and 24 (-0.95[1.26]%, P<0.0001; ‑1.15[1.40]%, P<0.0001, respectively), with no increase in hypoglycaemia (<4 mmol/L). Reductions in percentage of high glucose values (>10 mmol/L) were seen at weeks 12 and 24 (-8.3[22.9]%, P=0.0017; -9.7[28.9]%, P=0.0036, respectively). Slight decrease in diabetes-related distress was seen at week 12 (-0.16[0.74], P=0.0609) becoming significant by week 24 (-0.22[0.83], P=0.0226).
Conclusions: In this observational study, use of ‘structured SMBG’ by Australian adults with non-insulin-treated type 2 diabetes, supported by their primary care clinicians, appears to significantly improve glycaemic control and reduce diabetes-related distress. While the lack of control group is a limitation, these findings support previous RCT evidence and suggest that ‘structured SMBG’ can be effective for adults with non-insulin-treated type 2 diabetes.
This study was supported by Roche Diagnostics Australia & Roche Diagnostics GmbH