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Evaluating Once- and Twice-Daily Self-Monitored Blood Glucose Testing Strategies for Stable Insulin-Treated Patients With Type 2 Diabetes

The Diabetes Outcomes in Veterans Study

¹ Department of Medicine, New Mexico VA Health Care System, Albuquerque, New Mexico
² Southern Arizona VA Health Care System, Tucson, Arizona
³ Departments of Medicine and Radiology, University of Arizona College of Medicine, Tucson, Arizona
⁴ Department of Medicine, Carl T. Hayden VA Medical Center, Phoenix, Arizona

OBJECTIVE—To evaluate once- and twice-daily self-monitored blood glucose testing strategies in assessing glycemic control and detecting hypoglycemia or hyperglycemia in patients with stable insulin-treated type 2 diabetes.

RESEARCH DESIGN AND METHODS—Subjects with stable insulin-treated type 2 diabetes monitored blood glucose four times daily (prebreakfast, prelunch, predinner, and bedtime) for 8 weeks. We correlated mean blood glucose values with HbA_1c measured after 8 weeks and determined the number of hypoglycemic (3.33 mmol/l) and hyperglycemic (22.20 mmol/l) readings captured at the various testing times.

RESULTS—A total of 150 subjects completed the monitoring period; their average age was 67 years, 90% were men, and the mean HbA_1c at baseline was 8.0 ± 1.8%. The overall correlation of glucose testing and HbA_1c was 0.79 (P < 0.0001). Mean blood glucose values for each of the four once-daily testing strategies were significantly correlated with HbA_1c (r = 0.65–0.70, P < 0.0001), as were mean blood glucose values for each of the six twice-daily testing strategies (r = 0.73–0.75, P < 0.0001). The prebreakfast/prelunch measurements captured the largest proportion (63.6%) of the hypoglycemic readings, the predinner/bedtime measurements captured the largest proportion (66.2%) of hyperglycemic readings, and the prelunch/predinner measurements captured the largest proportion (57.7%) of all out-of-range readings.

CONCLUSIONS—Twice-daily testing strategies, particularly prelunch/predinner, effectively assess glycemic control and capture a substantial proportion of out-of-range readings. However, personal testing strategies will vary depending on an individual’s risk for hypoglycemia and hyperglycemia.

Abbreviations: NHANES III, third National Health and Nutrition Examination Survey • SMBG, self-monitoring of blood glucose

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