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Close Eye on Blood Sugar Aids Structured and 1 Year Glycemic Control in T2DM. Diab Care

 

    Note that in this multicenter, randomized trial, non-insulin dependent diabetics who performed intensive self-monitoring of blood glucose had greater reduction of A1C at one year than controls.

    Be aware that the net difference in A1c, 0.1%, while statistically significant, may not be clinically relevant given the intensity of the intervention.

Using an intensely structured system of self-monitoring blood glucose (SMBG) improved glycemic control even in patients with type 2 diabetes who were well-controlled, researchers reported.

In the prospective, randomized PRISMA study, patients using the structured approach to monitoring had a significantly greater reduction in HbA1c over 1 year than those who performed regular monitoring of blood sugar (-0.45% versus -0.24%, P=0.0007), Francesco Giorgino, MD, of the University of Bari in Italy, and colleagues reported online in Diabetes Care.

”Use of intensive, structured SMBG data by clinicians to optimize prescription of diabetes medications and by patients to modify their behaviors improved glycemic control,” they wrote.

The value of SMBG remains controversial in T2DM, given that some studies have shown clinicians and patients make little use of the data in order to improve outcomes. But some recent work has shown that monitoring that is highly structured, in terms of both timing and frequency, may help improve outcomes — even in patients who have a lower HbA1c but aren’t quite at glycemic targets.

Giorgino and colleagues conducted the PRISMA study to assess whether highly structured SMBG can improve glycemic control over 12 months in patients with type 2 diabetes who aren’t on insulin.

A total of 1,024 patients were enrolled at 39 diabetes clinics in Italy with a median baseline HbA1c of 7.3%.

After standardized education, 501 patients were randomized to intensive structured monitoring with 4-point glycemic profiling (fasting, preprandial, 2-hour postprandial, and post-absorptive measurements) 3 days a week.

The remaining 523 patients were randomized to active control with 4-point glycemic profiling performed at baseline and at 6 and 12 months.

There were two primary endpoints: change in HbA1c at 12 months and percentage of patients achieving glycemic targets.

In an intent-to-treat (ITT) analysis, Giorgino and colleagues found significantly greater reductions in HbA1c over 12 months among those in the intensive, structured monitoring group compared with controls (-0.39% versus -0.27%, P=0.013).

In a per-protocol analysis, the between-group difference was even greater, at -0.45% versus -0.24% (P=0.0007).

In both analyses, more patients in the intense monitoring group achieved clinically meaningful reductions in HbA1c at study end (P<0.025).

In the ITT population, a similar proportion of patients in both groups reached or maintained their risk target at 1 year (74.6% for intense monitoring and 70.1% of controls), but in the per-protocol analysis, the proportion was significantly higher for intense monitoring (90% versus 82.5%, P=0.038).

The researchers also found in the ITT analysis that prescriptions for diabetes medications were changed more often at visits two, three, and four for the intense-monitoring group than for controls (P<0.001).

That suggested that ”structured SMBG data prompted clinicians to adjust therapy earlier and more intensively in contrast to the clinical inertia often seen in the management of patients with type 2 diabetes,” they wrote.

”It is reasonable to assume that the treatment algorithm based on structured SMBG findings helped clinicians select the most appropriate medication for each patient’s glucose pattern,” they added.

Giorgino and colleagues cautioned, however, that intense-monitoring patients reported a greater incidence of nonsevere hypoglycemic events. These, however, were likely the result of increased detection of hypoglycemia attributable to greater SMBG frequency, they wrote.

The study was limited because patients were treated at diabetes clinics and thus it may be difficult to generalize the findings to those treated at primary care practices. Also, the study didn’t allow for assessment of the effect of the comprehensive education provided and of the increased attention given to patients in both study groups.

Still, the researchers concluded, the findings ”confirm the clinical usefulness and overall safety of using structured SMBG to provide guidance in the prescription of diabetes medications and lifestyle changes in non-insulin-treated type 2 diabetic patients, ultimately improving glycemic control.”

Source reference:
Bosi E, et al ”Intensive structured self-monitoring of blood glucose and glycemic control in noninsulin-treated type 2 diabetes: The PRISMA randomized trial” Diabetes Care 2013; DOI: 10.2337/dc13-0092.

From http://www.medpagetoday.com

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