Self-monitoring Of Blood Glucose Group Research Articles

Clinical Effectiveness of Continuous Glucose Monitoring in Pregnancies Affected by Type 1 Diabetes.

Background: Continuous glucose monitoring (CGM) improves neonatal outcomes in type 1 diabetes pregnancies; however, its effectiveness has not been assessed in a real-world setting in the United States. Objective: The Triple C Study aimed to examine the clinical effectiveness, assessed through maternal glucose control and gestational health outcomes, of CGM use compared with self-monitoring of blood glucose (SMBG) in pregnancies associated with type 1 diabetes in a real-world setting. Research Design and Methods: We retrospectively identified 160 type 1 diabetes pregnancies at the Barbara Davis Center for Diabetes managed with CGM therapy (n = 109) or SMBG (n = 51) over a 6.5-year period (2014-2020). Obstetric care was provided at multiple practices. CGM use was defined as ≥60% wear in the second and third trimesters of pregnancy. Data were obtained from the electronic medical record system, hospital records, and vital statistics departments (Colorado and Wyoming). We used Student's t-test for continuous variables and chi-square test for categorical variables to compare outcomes between groups. Results: The CGM group had more participants meeting trimester-specific hemoglobin A1C (HbA1c) goals throughout pregnancy and postpartum (P < 0.01 in each time period). The CGM group had fewer participants never meeting HbA1c goals in any trimester than the SMBG group (P < 0.001). There were no significant differences in neonatal outcomes between groups, other than for macrosomia (12.8% CGM vs. 29.4% SMBG, P = 0.01). Infants of CGM users required a neonatal intensive care unit admission less often (52.9% CGM vs. 68.3% SMBG, P = 0.0989). Conclusions: CGM use was associated with improved maternal glucose levels in a diverse real-world cohort.

273-OR: Hybrid Closed-Loop Therapy vs. Other Modalities of Therapy during Ramadan Intermittent Fasting in Adults and Adolescents with Type 1 Diabetes

Introduction: Most people with type 1 diabetes (PwT1D) are considered high risk to fast during the month of Ramadan. Yet, many of them attempt to fast and abstain from eating and drinking from dawn to dusk. Here, we evaluate the association between the sociodemographic indicators, modality of T1D treatment, and number of days when fasting is broken due to diabetes among PwT1D. Methods: We surveyed 294 PwT1D who attempted to fast during Ramadan 2022, were seen at our Endocrine clinics during the month preceding Ramadan, and who agreed to share their health information and fasting experience. Participants were categorized into 5 groups based on their treatment modality: a) Pump + CGM [Hybrid closed loop (HCL)] (n=62); b) Pump + CGM [Conventional open loop] (n=37); c) Pump + Self-monitoring of blood glucose (SMBG) (n=8); d) Multiple daily injections (MDI) + CGM (n=155); e) MDI + SMBG (n=32). Predictors for fasting most days of Ramadan (i.e. breaking fast ≤ 2 days) were analyzed using uni- and multi-variable logistic regression. Results: Private health insurance rates were highest among pump users (82%, 63%, and 41% for HCL, Pump + SMBG, and conventional open loop, respectively); whereas, MDI users had the lowest insurance rates (25% and 21% for MDI + SMBG and MDI + CGM, respectively). The median numbers of days when fasting was broken due to diabetes were 2, 5, 3, 3.5, and 2.5 days among the HCL, conventional open loop, MDI + CGM, Pump + SMBG, and MDI + SMBG groups, respectively (p=.047). Users of HCL therapy were two times as likely to complete fasting most days of Ramadan (i.e. breaking fast ≤2 days) compared to MDI + CGM users [odds ratio (95% CI): 2.37 (1.14, 4.90)] after adjusting for age, sex, educational level, employment status, insurance status, and diabetes duration. Conclusion: Among the common treatment modalities of T1D, the use of HCL pump therapy is associated with the highest rates of fasting most days of Ramadan after adjusting for potential confounders. Disclosure M.Al-sofiani: Consultant; Eli Lilly and Company, Speaker's Bureau; Sanofi, Medtronic, Vitalair. S.Alharthi: None. S.Albunyan: Employee; ProMedEx, Medtronic. N.Alzaman: None. D.C.Klonoff: Consultant; EOFlow Co., Ltd., Fractyl Health, Inc., Integrity, Lifecare, Inc., Rockley Photonics, Thirdwayv Inc. A.M.Alguwaihes: Consultant; Eli Lilly and Company, Research Support; AstraZeneca, Novo Nordisk, Speaker's Bureau; Novo Nordisk, Sanofi.

An Observational Crossover Study of People Using Real-Time Continuous Glucose Monitors Versus Self-Monitoring of Blood Glucose: Real-World Evidence Using EMR Data From More Than 12,000 People With Type 1 Diabetes.

We used real-world electronic health record (EHR) data to examine HbA1c levels among children and adults with type 1 diabetes (T1D) who are classified as continuous glucose monitor (CGM) users after T1D diagnosis and switch to self-monitoring of blood glucose (SMBG) during follow-up, versus people who opt for SMBG after T1D diagnosis and switch to CGM during follow-up visits. We conducted an observational, case-crossover study using electronic medical record (EMR) data from the T1D Exchange Quality Improvement Collaborative. The primary outcome in this study was HbA1c. Baseline HbA1c levels were taken at the index date, corresponding to initial device classification, and compared with HbA1c value recorded at the clinic visit following device switch. Of all patients classified in the SMBG group, 7,706 switched to CGM use within the 5-year study time frame, and 5,123 of all initial CGM users switched to SMBG within the study time frame and were included in this analysis. At baseline, median (interquartile range [IQR]) HbA1c for SMBG use was 8.1 (2.4), whereas postcrossover to CGM use, there was a decline in median (IQR) levels to 7.7 (1.9) (P < .001). For baseline CGM users, median (IQR) HbA1c levels were 7.9 (2.0), and postcrossover to SMBG, median (IQR) HbA1c levels increased to 8.0 (2.9) (P < .001). We found that people who switched to CGM use had significantly improved HbA1c levels compared to those who switched to glucose monitoring with SMBG.

Prevalence, characteristics, and health-related quality of life of continuous glucose monitoring use according to the Behavioral Risk Factor Surveillance System 2014-2020.

BACKGROUND: Continuous glucose monitoring (CGM) can improve behavioral and clinical outcomes. The use of CGM in real-world practice appears to be increasing. However, actual prevalence and characteristics of using CGM in real-world practice are unknown. OBJECTIVE: To investigate the prevalence of CGM use by American adults with diabetes mellitus and differences in demographics and health-related quality of life (HRQOL) between users of CGM and self-monitoring of blood glucose (SMBG). METHODS: This serial cross-sectional study using 2014-2020 Behavioral Risk Factor Surveillance System data included nonpregnant adults with self-reported diabetes using CGM or 4-15 times daily SMBG. Outcomes were prevalence of CGM use, demographics, and the 4-item Centers for Disease Control and Prevention HRQOL (CDC HRQOL-4). Unadjusted analysis was performed using univariable regression, and adjusted analysis was performed using nearest neighbor matching to compare CDC HRQOL-4 between SMBG and CGM groups in SAS Studio version 5.2. RESULTS: Among 12,053 included respondents, 231 (1.9%) reported using CGM, and prevalence increased from 0.4% in 2014 to 4.1% in 2020. Compared with SMBG users, CGM users were more likely to be younger (50.3 years vs 56.1 years; P < 0.001), employed (59.6% vs 30.6%; P = 0.001), earn at least $75,000/year (48.5% vs 22.0%, P < 0.001), have insurance coverage (99.7% vs 95.4%; P = 0.005), and report fewer comorbidities (history of myocardial infarction, stroke, arthritis, depressive disorder, and kidney disease; all P < 0.05). After nearest neighbor matching, diabetes management-related characteristics were shown to have statistically significant differences between CGM and SMBG users including: age at diabetes diagnosis (30.6 vs 35.6 years; P = 0.005), not seeing a doctor because of cost concern (2.6% vs 7.8%; P = 0.011), checking hemoglobin A1c biannually (91.3% vs 86.6%; P = 0.047), performing daily foot self-examination (58.9% vs 69.6%; P = 0.028), receiving foot examination by a health care professional annually (87.9% vs 93.5%; P = 0.048), and receiving a shingles vaccine in the past (16.5% vs 10.1%; P = 0.024). CDC HRQOL-4 were shown to be similar between the 2 groups across the 4 domains (general health, physical, mental, and combined physical and mental health). CONCLUSIONS: An increased trend in CGM use was observed from 2014 to 2020. Economic factors were associated with CGM use over SMBG, and CGM use did not show a difference in HRQOL measured across the 4 domains.

Effect of Different Glucose Monitoring Methods on Bold Glucose Control: A Systematic Review and Meta-Analysis.

Objective To evaluate the effectiveness of different glucose monitoring methods on blood glucose control and the incidence of adverse events among patients with type 1 diabetes mellitus. Methods Using the method of literature review, the databases PubMed, Cochrane, and Embase were retrieved to obtain relevant research literature, and the selected studies were analyzed and evaluated. This study used Cochrane software RevMan5.4 to statistically analyze all the data. Results A total of 15 studies were included in this study, including 10 randomized controlled trials and 5 crossover design trials, with a total of 2071 patients. Meta-analysis results showed that continuous blood glucose monitoring (CGM) could significantly reduce the HbA1c level of patients, weighted mean difference (WMD) = −2.69, 95% confidence interval (CI) (-4.25, -1.14), and P < 0.001 compared with self-monitoring of blood glucose (SMBG). Meanwhile, the incidence of severe hypoglycemia in the CGM group was significantly decreased, risk ratio (RR) = 0.52, 95% CI 0.35-0.77, and P = 0.001. However, there was no statistical difference in the probability of diabetic ketoacidosis between CGM and SMBG groups, RR = 1.34, 95% CI 0.57-3.15, and P = 0.5. Conclusion Continuous blood glucose monitoring is associated with lower blood glucose levels than the traditional blood glucose self-test method.

Novel Continuous Glucose Monitoring Metrics and Large-for-Gestational-Age Risk: An Exploratory Retrospective Cohort Study in Pregnancies with Type 1 Diabetes

Background: Continuous glucose monitoring (CGM) improves pregnancy outcomes in patients with type 1 diabetes (T1D). We aimed to assess the between-group differences in glycated hemoglobin (HbA1c) and the incidence of large-for-gestational-age (LGA) neonates in CGM and glucometer users and analyze the potential association of novel CGM metrics with LGA risk in T1D pregnancies. Materials and Methods: Our retrospective study cohort included 134 women with T1D treated with insulin pumps-75 of them used CGM and 59 patients measured their glucose concentrations using glucometers only. As part of our study, we matched the CGM users and patients who preferred the self-monitoring of blood glucose (SMBG) according to their baseline HbA1c and White's diabetes class at a 1:1 ratio. After the matching, both groups included 42 pregnancies. Results: We did not find any difference in changes in HbA1c and perinatal outcomes between CGM and SMBG users; however, we achieved a limited statistical power, and there were more cases of diabetic nephropathy in the SMBG group. Mothers of LGA infants had higher first-trimester HbA1c, time above target, and mean glucose concentrations in each trimester of pregnancy. Other CGM metrics reflecting glucose fluctuations attributed to hyperglycemia were associated with an increased risk of LGA. Despite optimal maternal HbA1c, 39% of neonates demonstrated LGA. Conclusions: Although participants reached the target HbA1c concentrations, mothers of LGA newborns had higher first-trimester HbA1c, as well as higher time above target range, higher mean glucose concentrations, and more glycemic fluctuations, suggesting that several CGM metrics associated with maternal hyperglycemia are associated with LGA in pregnancies with T1D.

Glucometers for Patients with Type 2 Diabetes Mellitus: Are they helpful?

Background: The effectiveness of self-monitoring of blood glucose (SMBG) in type 2 diabetes mellitus (T2DM) patients is debated in the literature. We aimed at elucidating the association and patterns of complications between SMBG use and plasma glucose values.&#x0D; Methods: This cross-sectional study comprised 303 participants from outpatient departments with T2DM for over 12 months. We analyzed sociodemographic and clinical variables including: anthropometry, SMBG use, disease duration, treatment modality, complications, plasma glucose level, and glycated hemoglobin level (%).&#x0D; Results: The mean duration of T2DM was 93±76 months. Participants were grouped into SMBG users (n=115, 38%) and non-SMBG users (n=188, 62%). The mean fasting plasma glucose levels of SMBG and non-SMBG users were 140.7±42.7 (95% Confidence Interval [95%CI]: 132.72;148.67) mg/dl and 145.4±50 (95%CI: 138.12;152.67) mg/dl (p=0.03), respectively. The mean post-prandial plasma glucose levels of the SMBG and non-SMBG groups were 202±63.42 (95%CI: 190.23;213.76) mg/dl and 209±84.54 (95%CI: 196.56;221.43) mg/dl (p=0.002), respectively. The mean difference in HbA1c among the groups were 8.14±1.69% (95%CI: 7.59;8.68) and 8.15±1.98% (95%CI: 7.27;9.02) (p=0.4), respectively. Hypoglycemia (n=50, 43.5%) was the most common complication. The prevalence of neuropathy (n=5, 4.3%, p=0.036) and cardiovascular disease (n=21, 18.3%, p=0.042) were significantly higher in the SMBG group.&#x0D; Conclusion: Although plasma glucose values were significantly lower in the SMBG group, its clinical significance remains questionable. Furthermore, many participants in both the groups had shortfalls in awareness, monitoring, and glycemic control. SMBG use needs to be evaluated in a cohort of patients with T2DM with adequate health awareness.

Episodic Real-Time CGM Use in Adults with Type2 Diabetes: Results of a Pilot Randomized Controlled Trial.

IntroductionResistance to initiating insulin therapy is common for people with type 2 diabetes (T2D) using multiple oral agents, resulting in sustained poor glycemic control. We explored a non-pharmacologic option and examined whether adults with T2D and elevated hemoglobin A1c (HbA1c) who were using multiple, non-insulin antihyperglycemics could obtain glycemic benefit from limited, episodic use of real-time continuous glucose monitoring (rtCGM).MethodsA randomized, pilot trial enrolled patients with T2D who were using two or more non-insulin therapies and had HbA1c values of 7.8–10.5%. Following a baseline, 10-day, blinded CGM session, participants were randomized 2:1, rtCGM or self-monitoring of blood glucose (SMBG). Medication changes were not made during the 12-week study unless required for safety; benefits would result from lifestyle changes. The rtCGM group used unblinded rtCGM for three sessions at weeks 0, 4, and 8, and the control group managed diabetes with SMBG and wore blinded rtCGM at week 8. Glycemic endpoints were assessed.ResultsSeventy participants were enrolled from eight North American sites and data were available from 68 (n = 45 rtCGM; n = 23 SMBG). Median (IQR) baseline HbA1c was 8.4 (0.8)% and 8.3 (1.2)% and median (IQR) change in HbA1c at week 12 was − 0.5 (1.3)% and − 0.2 (1.1)% for the rtCGM and SMBG groups, respectively (between-group difference p = 0.74). More than one-third (34.1%) of the rtCGM group vs 17.4% of the SMBG group reached the HbA1c goal of less than 7.5% at week 12 (between-group difference p = 0.12). Compared to run-in, mean (SD) time in range (TIR 70–180 mg/dL) at week 8 increased for the rtCGM group (56.3 [24.5]% vs 63.1 [25.5]%) while it decreased for the SMBG group (68.4 [21.5]% vs 55.1 [30.3]%). HbA1c reductions were not sustained at month 9.ConclusionIn this pilot study, limited episodic rtCGM use in people failing multiple non-insulin therapies resulted in modest, short-term glycemic benefits.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01086-y.

The cost implications of continuous glucose monitoring in pregnant women with type 1 diabetes in 3 Canadian provinces: a posthoc cost analysis of the CONCEPTT trial.

Background:The Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial (CONCEPTT) found improved health outcomes for mothers and their infants among those randomized to self-monitoring of blood glucose (SMBG) with continuous glucose monitoring (CGM) compared with SMBG alone. In this study, we evaluated whether CGM or standard SMBG was more or less costly from the perspective of a third-party payer.Methods:We conducted a posthoc analysis of data from the CONCEPTT trial (Mar. 25, 2013, to Mar. 22, 2016). Health care resource data from 215 pregnant women, randomized to CGM or SMBG, were collected from 31 hospitals in 7 countries. We determined resource costs posthoc based on prices from hospitals in 3 Canadian provinces (Ontario, British Columbia, Alberta). The primary outcome was the difference between groups in the mean total cost of care for mother and infant dyads, paid by each government (i.e., the third-party payer) from randomization to hospital discharge (time horizon). The secondary outcome included CGM and SMBG costs not paid by governments (e.g., glucose monitoring devices and supplies).Results:The mean total cost of care was lower in the CGM group compared with the SMBG group in each province (Ontario: $13 270.25 v. $18 465.21, difference in mean total cost [DMT] −$5194.96, 95% confidence interval [CI] −$9841 to −$1395; BC: $13 480.57 v. $18 762.17, DMT −$5281.60, 95% CI −$9964 to −$1382; Alberta: $13 294.39 v. $18 674.45, DMT −$5380.06, 95% CI −$10 216 to −$1490). There was no difference in the secondary outcome.Interpretation:Government health care costs are lower when CGM is paid by the patient, driven by lower costs from reduced use of the neonatal intensive care unit in the CGM group; however, when governments pay for CGM equipment, there is no overall cost difference between CGM and SMBG. Governments should consider paying for CGM, as it results in improved maternal and neonatal outcomes with no added overall cost. Trial registration:ClinicalTrials.gov, no. NCT01788527

Self-monitoring of blood glucose in association with glycemic control in newly diagnosed non-insulin-treated diabetes patients: a retrospective cohort study

The benefits of self-monitoring of blood glucose (SMBG) on glycemic control among type 2 diabetes (T2DM) patients not receiving insulin remains controversial. This study aimed to examine the association between SMBG and glycemic control in these patients. This retrospective longitudinal study enrolled 4987 eligible patients from a medical center in Taiwan. Data were collected from electronic medical records at 0 (baseline), 3, 6, 9, and 12 (end-point) months after enrollment. Patients were assigned to the early SMBG group or to the non-user group depending on whether they performed SMBG at baseline. Differences in glycated hemoglobin (HbA1c) reduction between groups at each time-point were assessed using SMBG group-by-time interaction in generalized estimating equations models, which were established using backward elimination method for multivariate regression analysis. Subgroup analyses for patients using non-insulin and insulin secretagogues were performed additionally. The estimated maximal difference in HbA1c reduction between groups (early SMBG users vs. non-users) was 0.55% at 3 months. Subgroup analyses showed maximal differences of 0.61% and 0.52% at 3 months in the non-insulin and insulin secretagogues groups, respectively. SMBG group-by-time interaction was statistically significant at 3 months and lasted for 12 months. The finding suggests that performing SMBG at disease onset was positively associated with better glycemic control in newly diagnosed non-insulin-treated T2DM patients, regardless whether non-insulin secretagogues or insulin secretagogues were used.

Flash glucose monitoring helps achieve better glycemic control than conventional self-monitoring of blood glucose in non-insulin-treated type 2 diabetes: a randomized controlled trial.

IntroductionThe present study aimed to evaluate the effects of flash glucose monitoring (FGM) and conventional self-monitoring of blood glucose (SMBG) on glycemic control in patients with non-insulin-treated type 2 diabetes.Research design and methodsIn this 24-week, multicenter, open-label, randomized (1:1), parallel-group study, patients with non-insulin-treated type 2 diabetes at five hospitals in Japan were randomly assigned to the FGM (n=49) or SMBG (n=51) groups and were provided each device for 12 weeks. The primary outcome was change in glycated hemoglobin (HbA1c) level, and was compared using analysis of covariance model that included baseline values and group as covariates.ResultsForty-eight participants in the FGM group and 45 in the SMBG group completed the study. The mean HbA1c levels were 7.83% (62.1 mmol/mol) in the FGM group and 7.84% (62.2 mmol/mol) in the SMBG group at baseline, and the values were reduced in both FGM (−0.43% (−4.7 mmol/mol), p<0.001) and SMBG groups (−0.30% (−3.3 mmol/mol), p=0.001) at 12 weeks. On the other hand, HbA1c was significantly decreased from baseline values in the FGM group, but not in the SMBG group at 24 weeks (FGM: −0.46% (−5.0 mmol/mol), p<0.001; SMBG: −0.17% (−1.8 mmol/mol), p=0.124); a significant between-group difference was also observed (difference −0.29% (−3.2 mmol/mol), p=0.022). Diabetes Treatment Satisfaction Questionnaire score was significantly improved, and the mean glucose levels, SD of glucose, mean amplitude of glycemic excursions and time in hyperglycemia were significantly decreased in the FGM group compared with the SMBG group.ConclusionsGlycemic control was better with FGM than with SMBG after cessation of glucose monitoring in patients with non-insulin-treated type 2 diabetes.Trial registration numberUMIN000026452, jRCTs041180082.

SAT-648 Flash Glucose Monitoring Helps Achieve Better Glycemic Control Than Conventional Self-Monitoring of Blood Glucose in Non-Insulin-Treated Type 2 Diabetes: A Randomized Controlled Trial

Background and aims: Flash glucose monitoring (FGM) is a novel system with which glucose levels are monitored and has been reported to improve glucose variability and glycemic control in type 1 and type 2 diabetes patients treated with insulin. The present study aimed to evaluate the effects of FGM and conventional self-monitoring of blood glucose (SMBG) on glycemic control in patients with non-insulin-treated type 2 diabetes. Reseach design and Methods: In this 24-week, multicenter, open-label, randomized (1:1), parallel group study, non-insulin-treated type 2 diabetic patients at 5 hospitals in Japan were randomly assigned to the FGM (n = 49) or SMBG (n = 51) groups and were provided FGM or SMBG devices for 12 weeks. The primary outcome was change in glycated hemoglobin (HbA1c) level. This trial is registered with UMIN-CTR (UMIN000026452). Results: Forty-eight participants in the FGM group and 45 in the SMBG group completed the study. The mean HbA1c levels were 7·83% (SD 0·25) in the FGM group and 7·84% (SD 0·27) in the SMBG group at baseline, and the values were reduced in both FGM (−0·43%; 95% confidence interval [CI], −0·57 to −0·28; p < 0·0001) and SMBG groups (−0·30%; 95% CI −0·48 to −0·13; p = 0·001) at 12 weeks. On the other hand, HbA1c was significantly decreased from baseline values in the FGM group, but not in the SMBG group at 24 weeks (FGM: −0·46%, 95% CI −0·59 to −0·32, p < 0·0001; SMBG: −0·17%, 95% CI −0·05 to 0·11, p = 0·124); a significant between-group difference was also observed (difference −0·29%, 95% CI −0·54 to −0·05; p = 0·022). Diabetes Treatment Satisfaction Questionnaire score was significantly improved, and the mean glucose levels, standard deviation of glucose, mean amplitude of glycemic excursions, and duration of hyperglycemia were significantly decreased in the FGM group compared with the SMBG group. Conclusions: Glycemic control was better with FGM than with SMBG after cessation of glucose monitoring in non-insulin-treated type 2 diabetic patients.

Equivalent Efficacy of Intensive Self-Monitoring of Blood Glucose to Real-Time Continuous Glucose Monitoring in Adults with Type 2 Diabetes

Effectiveness of real time continuous glucose monitoring (RT-CGM) compared with intensive self-monitoring of blood glucose (SMBG) is not clear. To analyze the effectiveness of RT-CGM, retrospective CGM and, intensive SMBG in adults with type 2 diabetes, we conducted a randomized, open-labelled clinical trial. Patients were type 2 diabetes adults admitted to our hospital from August 2016 to August 2017. Patients of age over 85 years, pregnant, admission less than 1 week were excluded. Patients were randomized to SMBG with RT-CGM using the Medtronic MiniMed 620G, SMBG with retrospective CGM using Medtronic iPro2, or SMBG alone. Both CGMs were worn for 6 days. SMBG was done 6 times a day at every pre-meal and 2 hours post-meal. Primary outcome was the change in HbA1c from baseline to 12weeks. As the secondary outcomes, change in mean glucose level from the admission day to discharge day, and frequency of in-hospital hypoglycemia were evaluated. We also evaluated patients’ satisfaction to treatment using Diabetes Treatment Satisfaction Questionnaire (DTSQ). As the result, 111 patients were enrolled and 33 patients were allocated to RT-CGM group, 26 to retrospective CGM group, and 52 to SMBG group. Among these 111 patients, 63 (56.8%) were male, mean age was 65.1 years, diabetes duration was 8.3 years, BMI was 26.3 kg/m^2, and HbA1c was 9.1%. Overall, glycemic control was improved after treatment for both HbA1c and the mean glucose level; HbA1c from 9.1±1.7% to 6.8±1.0%, mean glucose level from 189±56mg/dl to 137±19mg/dl. However, the changes were not significantly different between the groups. As the safety profile, 34 hypoglycemia was seen during hospitalization with no difference in frequency between the groups (P=0.11). There were no differences in patients’ satisfaction to treatment assessed by DTSQ, either. In conclusion, among adults with type 2 diabetes, intensive SMBG may have the equivalent effect to RT-CGM and retrospective CGM. Disclosure Y. Takano: None. Y. Namiki: None. H. Hiiragi: None. T. Yamada: None. H. Sasaki: None. Y. Murohashi: None. H. Takamine: None. K. Inazumi: None. Y. Terauchi: Research Support; Self; MSD K.K.. Speaker's Bureau; Self; MSD K.K.. Advisory Panel; Self; MSD K.K.. Research Support; Self; Ono Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd.. Research Support; Self; Novartis Pharma K.K., Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Mitsubishi Tanabe Pharma Corporation. Advisory Panel; Self; Mitsubishi Tanabe Pharma Corporation. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Daiichi Sankyo Company, Limited. Advisory Panel; Self; Daiichi Sankyo Company, Limited. Research Support; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Speaker's Bureau; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Advisory Panel; Self; Sanofi. Research Support; Self; Sumitomo Dainippon Pharma Co., Ltd.. Speaker's Bureau; Self; Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Shionogi &amp; Co., Ltd.. Speaker's Bureau; Self; Shionogi &amp; Co., Ltd., Bayer Yakuhin, Ltd., Astellas Pharma US, Inc., AstraZeneca. Advisory Panel; Self; AstraZeneca, Teijin Pharma Limited. U.N. Osada: None.

Educational disparities in the associations between self-monitoring of blood glucose and glycemic control in type 2 diabetes patients in Xiamen, China.

This study examined the combined effects of self-monitoring of blood glucose (SMBG) and educational attainment on glycemic control in type 2 diabetes mellitus (T2DM) patients. A cross-sectional survey was performed among community residents with T2DM. Good glycemic control was defined as HbA1c <7% in the most recent measurement. Multivariable logistic regression was used to examine associations of glycemic control with SMBG, educational attainment, and their combined effects by controlling for certain covariates, with further stratification by sex. Complete data were available for 798 patients, of which 58.52% had good glycemic control. Higher education and SMBG were associated with good glycemic control (P < 0.05). In the SMBG group, tertiary-educated patients had the greatest odds of good glycemic control (odds ratios 2.56; 95% confidence interval 1.31-4.99). Among those performing SMBG, the odds of good glycemic control were higher for those with higher education levels (Ptrend = 0.003), whereas there was no clear trend for those not performing SMBG (Ptrend = 0.071). For subjects attaining secondary and tertiary education levels, the odds of good glycemic control were higher in those performing SMBG, although there was no significant difference between the two groups for those with a primary education. Glycemic control decreased slightly among males with a primary level education, but showed an increasing trend among females with a primary level education. Sex-specific educational disparities exist in the association between SMBG and glycemic control. More detailed guidelines for SMBG according to a subject's socioeconomic position and sex are required.

Effect of self-monitoring of blood glucose on glycaemic outcome among type 2 diabetic patients

Background: Diabetes mellitus is a chronic metabolic disorder which leads to complications especially when not properly managed. The role of self-monitoring of blood glucose (SMBG) in type 2 diabetic patients using oral hypoglycaemic agents has been a source of controversy.&#x0D; &#x0D; Objective: The objective was to study the effect of SMBG on glycaemic outcome among type 2 diabetics in a primary care setting.&#x0D; &#x0D; Methodology: A randomised control study was conducted between March 2013 and November 2013 at the General Outpatient Clinic of the Family Medicine Department (FMD) in Lagos State University Teaching hospital. A total of 120 diabetic patients were randomised into intervention and control groups; 107 patients (55 in the intervention and 52 in the control group) completed the study. Intention-to-treat analysis was done. Chi-square, Students t- and paired t-test were used to determine variables significantly associated with SMBG.&#x0D; &#x0D; Results: More than three-quarters (77.5%) of the participants were aware of SMBG prior to commencement of the study. Both the SMBG (8.7% vs. 7.2%; p-value &lt; 0.001) and non-SMBG (8.7% vs 7.7%; p-value &lt; 0.001) groups had a significant improvement in HbA1c at the end of the study. Similarly there was a significant improvement in FBG among both groups (SMBG 153 mg/dl vs. 123 mg/dl; p-value &lt; 0.001 and non-SMBG (158 mg/dl vs. 137 mg/dl; p-value 0.022). The HbA1c at the end of the study was 7.2% for the SMBG vs 7.7% for the non-SMBG group with no statistical difference (p-value 0.174).&#x0D; &#x0D; Conclusion: The use of SMBG among type 2 DM patients did not result in better glycaemic control compared with patients who did not practise SMBG. It could be due to close follow-up and education of both groups.&#x0D; &#x0D; (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)&#x0D; &#x0D; S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1340250

Application of real-time continuous glucose monitoring in outpatient management system for type 1 diabetes mellitus

Objective To evaluate the effect of continuous glucose monitoring system(CGMS) in improving the current status of type 1 diabetes mellitus(T1DM) control and reducing the economic burden of the patients. Methods One hundred and fifteen patients with T1DM were randomly assigned to the CGMS group and the self-monitoring of blood glucose(SMBG) group respectively. The patients in CGMS group were on 72 h CGMS every 6 months, while SMBG group only with SMBG to guide the insulin dose adjustment. The levels of blood glucose and the statistics of the number of hypoglycemia and diabetic ketoacidosis were taken as the main observational indexes every 6 months. The chronic complication and the statistics of the number of hospitalizations and the total cost of treatment were made as the secondary observational index every 12 months. Results 2 h postprandial plasma glucose(2hPG) and mean blood glucose(MBG) in the CGMS group were lower than those in the SMBG group [(10.7±1.9 vs 11.5±2.7) mmol/L, (9.7±0.5 vs 10.6±0.7) mmol/L, P<0.05] in the clinical follow-up visit after 6 months. The per capita number of hypoglycaemia in the CGMS group was lower than that in the SMBG group[(7.9±2.6 vs 9.2±3.4) times, P<0.05]. In the outpatient follow-up re-visit to the patients after 6 months, fasting plasma glucose(FPG), 2hPG, MBG, and HbA1C of the patients in the CGMS group were lower than those in the SMBG group(t=4.71~9.75, P<0.05), the per capita numbers of hypoglycemia and DKA in the CGMS group were lower than those in the SMBG group(t=3.61~4.37, P<0.05). Conclusion The application of real-time continuous glucose monitoring in T1DM outpatient management may reduce the whole-day blood glucose of the patients, decrease the incidence risk of hypoglycemia, and improve the compliance of the treatment while without increasing the economic burden of the disease. (Chin J Endocrinol Metab, 2017, 33: 367-371) Key words: Real-time continuous glucose monitoring system; Diabetes mellitus, type 1; Outpatient management system; Control status; Economic burden of disease

The Impact of Continuous Glucose Monitoring on Markers of Quality of Life in Adults With Type 1 Diabetes: Further Findings From the DIAMOND Randomized Clinical Trial

Continuous glucose monitoring (CGM) improves glycemic control, but data are inconclusive about its influence on quality of life (QOL). We investigated the impact of 24 weeks of CGM use on QOL in adults with type 1 diabetes (T1D) who use multiple daily insulin injections. DIAMOND (Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes) was a prospective randomized trial that assessed CGM versus self-monitoring of blood glucose (SMBG) only in 158 adults with poorly controlled T1D. At baseline and study end, participants completed QOL measures that assessed overall well-being (WHO-5), health status (EQ-5D-5L), diabetes distress (DDS), hypoglycemic fear (worry subscale of the HFS-II), and hypoglycemic confidence (HCS). At study end, CGM participants completed the CGM Satisfaction Survey. Linear regression analyses compared treatment group changes in QOL outcomes over time. Associations between CGM satisfaction and change in QOL outcomes and in glycemic control indices were assessed. The CGM group demonstrated a greater increase in hypoglycemic confidence (P = 0.01) and a greater decrease in diabetes distress (P = 0.01) than the SMBG group. No significant group differences in well-being, health status, or hypoglycemic fear were observed. CGM satisfaction was not significantly associated with glycemic changes but was associated with reductions in diabetes distress (P < 0.001) and hypoglycemic fear (P = 0.02) and increases in hypoglycemic confidence (P < 0.001) and well-being (P = 0.01). CGM contributes to significant improvement in diabetes-specific QOL (i.e., diabetes distress, hypoglycemic confidence) in adults with T1D, but not with QOL measures not specific to diabetes (i.e., well-being, health status). CGM satisfaction was associated with most of the QOL outcomes but not with glycemic outcomes.

Blood glucose self-monitoring and internet diabetes management on A1C outcomes in patients with type 2 diabetes

ObjectivesThe purpose of this study was to determine any correlation between frequency of self-monitoring of blood glucose (SMBG), frequency of patient-provider communication of SMBG (reporting), and hemoglobin A1C for patients...

Continuous glucose monitoring in people with diabetes: the randomized controlled Glucose Level Awareness in Diabetes Study (GLADIS).

To investigate the best glucose monitoring strategy for maintaining euglycaemia by comparing self-monitoring of blood glucose with continuous glucose monitoring, with or without an alarm function. A 100-day, randomized controlled study was conducted at four European centres, enrolling 160 patients with Type 1 or Type 2 diabetes, on multiple daily insulin injections or continuous subcutaneous insulin infusion. Participants were randomized to continuous glucose monitoring without alarms (n=48), continuous glucose monitoring with alarms (n=49) or self-monitoring of blood glucose (n=48). Time spent outside the glucose target during days 80-100 was 9.9h/day for the continuous glucose monitoring without alarms group, 9.7h/day for the continuous glucose monitoring with alarms group and 10.6h/day for the self-monitoring of blood glucose group (P=0.18 and 0.08 compared with continuous glucose monitoring without and with alarms, respectively).The continuous glucose monitoring with alarms group spent less time in hypoglycaemia compared with the self-monitoring of blood glucose group (1.0h/day and 1.6h/day, respectively; 95% CI -1.2 to -0.1; P=0.030). Among those treated with continuous subcutaneous insulin infusion, time spent outside the glucose target was significantly different when comparing continuous glucose monitoring without alarms and self-monitoring of blood glucose (-1.9h/day; 95% CI -3.8 to 0.0; P=0.0461) and when comparing continuous glucose monitoring with alarms and self-monitoring of blood glucose (-2.4h/day; 95% CI -4.1 to -0.5; P=0.0134). There was no difference in HbA1c reduction from baseline in the three groups; however, the proportion of participants with a reduction of≥6mmol/mol (≥0.5%) was higher in the continuous glucose monitoring without alarms (27%) and continuous glucose monitoring with alarms groups (25%) than in the self-monitoring of blood glucose group (10.6%). This study shows that the use of continuous glucose monitoring reduces time spent outside glucose targets compared with self-monitoring of blood glucose, especially among users of insulin pumps.

The effects of structured self-monitoring of blood glucose on therapeutic effectiveness and adherence in patients with type 2 diabetes mellitus initiating insulin treatment

Aim. To compare the efficiency of standard and structured approaches to self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes mellitus (T2DM) initiating insulin treatment. Materials and Methods. This open prospective randomized clinical trial included 51 T2DM patients who initiated insulin therapy in either outpatient or inpatient setting. Subjects were randomized in standard and structured SMBG groups, the structured group used an advanced Accu-Chek 360 View protocol. Evaluation included clinical examination and laboratory testing of HbA1c levels at the beginning of the treatment and after 3 months of the follow-up period. Results. 70% of the structured self-monitoring group and 32% of the control group achieved therapeutic goals (p=0.008). Higher adherence was associated with better glycemic control in both groups ? and vice versa. However, among patients with low adherence, 73% of advanced SMBG group managed to achieve therapeutic goals vs. 19% in the control group (p=0.005). In addition, patients in the structured monitoring group gained less weight as compared to the control (1.0?2.88 kg vs. 3.2?2.56 kg; p=0.005). Conclusion. Structured SMBG commenced at the initiation of insulin therapy improves glycemic control in a greater fraction of patients, especially in those with low adherence to treatment. Structured SMBG also partially alleviates weight gain as side effect of insulin treatment.