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Aim  To examine the impact of structured self‐monitoring of blood glucose, with or without TeleCare support, on glycaemic control in people with sub‐optimally controlled Type 2 diabetes.    Methods  We conducted a 12‐month, multicentre, randomized controlled trial in people with established (>1 year) Type 2 diabetes not on insulin therapy, with sub‐optimal glycaemic control [HbA 1c  ≥58 to ≤119 mmol/mol (≥7.5% to ≤13%)]. A total of 446 participants were randomized to a control group ( n = 151) receiving usual diabetes care, a group using structured self‐monitoring of blood glucose alone ( n = 147) or a group using structured self‐monitoring of blood glucose with additional monthly ‘TeleCare’ support ( n = 148). The primary outcome was HbA 1c  at 12 months.    Results  A total of 323 participants (72%) completed the study; 116 (77%) in the control group, 99 (67%) in the self‐monitoring of blood glucose alone group and 108 (73%) in the self‐monitoring of blood glucose plus TeleCare group. Compared to baseline, the mean HbA 1c  was lower in all groups at 12 months, with reductions of 3.3 mmol/mol (95%  CI  –5.71 to –0.78) or 0.3% (95%  CI  –0.52 to –0.07;  P =0.01) in the control group, 11.4 mmol/mol (95%  CI  –14.11 to –8.76) or 1.1% (–1.29 to –0.81;  P <0.0001) in the group using self‐monitoring of blood glucose alone and 12.8 mmol/mol (95%  CI  –15.34 to –10.31) or 1.2% (95%  CI  –1.40 to ‐0.94;  P <0.0001) in the group using self‐monitoring of blood glucose plus TeleCare. This represents a reduction in HbA 1c  of 8.9 mmol/mol (95%  CI  –11.97 to –5.84) or 0.8% (95%  CI  –1.10 to ‐0.54;  P ≤0.0001) with structured self‐monitoring of blood glucose compared to the control group. Participants with lower baseline HbA 1c , shorter duration of diabetes and higher educational achievement were more likely to achieve HbA 1c  ≤53 mmol/mol (7.0%).    Conclusions  Structured self‐monitoring of blood glucose provides clinical and statistical improvements in glycaemic control in Type 2 diabetes. No additional benefit, over and above the use of structured self‐monitoring of blood glucose, was observed in glycaemic control with the addition of once‐monthly TeleCare support.  (Clinical trial registration no.: ISRCTN21390608)

diabetic medicine

Effect of structured self‐monitoring of blood glucose, with and without additional TeleCare support, on overall glycaemic control in non‐insulin treated Type 2 diabetes: the SMBG Study, a 12‐month randomized controlled trial