The Impact of Blood Glucose Self-Monitoring on Metabolic Control and Quality of Life in Type 2 Diabetic Patients
An urgent need for better educational strategies
- Monica Franciosi, MSC (BIOL)1,
- Fabio Pellegrini, MS1,
- Giorgia De Berardis, MSC (CHEM)1,
- Maurizio Belfiglio, MD1,
- Donatella Cavaliere, MD1,
- Barbara Di Nardo, HSDIP1,
- Sheldon Greenfield, MD2,
- Sherrie H. Kaplan, PHD, MPH2,
- Michele Sacco, MD1,
- Gianni Tognoni, MD1,
- Miriam Valentini, MD1,
- Antonio Nicolucci, MD1 and
- for the QuED Study Group
- 1Department of Clinical Pharmacology and Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
- 2Tufts University School of Medicine, Boston, Massachusetts
OBJECTIVE—The role of self-monitoring of blood glucose (SMBG) in type 2 diabetes is still a matter of debate. In the framework of a nationwide outcomes research program, we investigated the frequency of SMBG and its association with metabolic control and quality of life (QoL).
RESEARCH DESIGN AND METHODS—The study involved 3,567 patients with type 2 diabetes who were recruited by 101 outpatient diabetes clinics and 103 general practitioners. Patients completed a questionnaire investigating SMBG practice and QoL (diabetes-related stress, diabetes health distress, diabetes-related worries, and Centers for Epidemiologic Studies-Depression scale).
RESULTS—Data on SMBG were available for 2,855 subjects (80% of the entire study population). Overall, 471 patients (17%) stated that they tested their blood glucose levels at home ≥1 time per day, 899 patients (31%) tested their blood glucose levels ≥1 time per week, and 414 patients (14%) tested their blood glucose levels <1 time per week, whereas 1,071 patients (38%) stated that they never practiced SMBG. A higher frequency of SMBG was associated with better metabolic control among subjects who were able to adjust insulin doses, whereas no relationship was found in all other patients, irrespective of the kind of treatment. Multivariate analyses showed that an SMBG frequency ≥1 time per day was significantly related to higher levels of distress, worries, and depressive symptoms in non–insulin-treated patients.
CONCLUSIONS—Our findings suggest that SMBG can have an important role in improving metabolic control if it is an integral part of a wider educational strategy devoted to the promotion of patient autonomy. In patients not treated with insulin, self-monitoring is associated with higher HbA1c levels and psychological burden. Our data do not support the extension of SMBG to this group.
- CES-D, Centers for Epidemiologic Studies-Depression
- GP, general practitioner
- ISM, insulin dose self-management
- OR, odds ratio
- QoL, quality of life
- SMBG, self-monitoring of blood glucose
- TIBI, Total Illness Burden Index
Address correspondence and reprint requests to Antonio Nicolucci, MD, Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Via Nazionale, 66030 S. Maria Imbaro (CH), Italy. E-mail:.
Received for publication 14 March 2001 and accepted in revised form 30 July 2001.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.