Self-Monitoring of Blood Glucose (SMBG) in Youth with Poorly Controlled Type 2 Diabetes (T2D) in the TODAY Study

Abstract

Objective: Determine if SMBG increased after starting insulin in T2D youth with poor glycemic control in the TODAY study. Methods: Youth with recent onset T2D (n=699) were randomized to receive metformin ± rosiglitazone (rosi) or intensive lifestyle. They were asked to perform SMBG daily (supplies provided). When they reached primary outcome (PO; A1c ≥8% over 6 mon or inability to wean from temporary insulin due to metabolic decompensation), metformin (not rosi) was continued, daily insulin glargine started; dosing was intensified as needed. A1c and SMBG data for 2 year before and after PO were analyzed. SMBG% was defined as percent of days between visits when the meter was used ≥1 time. Results: Of 319 youth who reached PO, 298 started insulin and 282 had SMBG data. At PO, mean (SD) age was 15.8±2.3 year, 65.3% female, 38.3% non-Hispanic black, 16.3% Hispanic, 7.1% non-Hispanic white, BMI 35.5±7.9 kg/m2, and A1c 9.6±2.0%. Median SMBG% was 40% at PO which increased to 49% at 6 mo and fell to 41% at 1 year; 22% of youth tested ≥80% of days at PO, which increased to 25% at 6 mo and fell to 19% at 1 year. Compared with those who tested <80% at PO, youth who tested ≥80% were younger, with lower BMI and A1c. Use of SMBG was associated with ≥1% reduction in A1c at 6 and 1 year after insulin initiation (Figure). Conclusion: Adherence to SMBG was poor but associated with lower A1c. Research is needed on interventions to help youth with T2D reach A1c goals. Disclosure R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases. B. Braffett: None. C.L. Chan: None. N.T. Chang: None. M.W. Haymond: Advisory Panel; Self; Zealand Pharma A/S. Other Relationship; Self; Xeris Pharmaceuticals, Inc.. B. Schwartzman: None.