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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
Author(s) -
Parsons S. N.,
Luzio S. D.,
Harvey J. N.,
Bain S. C.,
Cheung W. Y.,
Watkins A.,
Owens D. R.
Publication year - 2019
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13899
Subject(s) - medicine , randomized controlled trial , telecare , diabetes mellitus , type 2 diabetes , blood glucose self monitoring , insulin , self monitoring , type 1 diabetes , endocrinology , continuous glucose monitoring , telemedicine , health care , economics , economic growth , psychology , social psychology
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)