Intensified Blood Glucose Monitoring Improves Glycemic Control in Stable, Insulin-Treated Veterans With Type 2 Diabetes
The Diabetes Outcomes in Veterans Study (DOVES)
- Glen H. Murata, MD1,
- Jayendra H. Shah, MD23,
- Richard M. Hoffman, MD1,
- Christopher S. Wendel, MS2,
- Karen D. Adam, RN1,
- Patricia A. Solvas, RN2,
- Syed U. Bokhari, MD4 and
- William C. Duckworth, MD34
- 1Department of Medicine, New Mexico VA Health Care System, Albuquerque, New Mexico
- 2Southern Arizona VA Health Care System, Tucson, Arizona
- 3Departments of Medicine and Radiology, University of Arizona College of Medicine
- 4Department of Medicine, Carl T. Hayden VA Medical Center, Phoenix, Arizona
OBJECTIVE—To examine the effect of intensified self-monitored blood glucose (SMBG) testing on glycemic control.
RESEARCH DESIGN AND METHODS—Subjects with stable, insulin-treated type 2 diabetes performed SMBG using an electronic blood glucose meter before all meals and at bedtime for 8 weeks. Baseline data were collected on demographics, clinical characteristics, diet, and exercise. HbA1c was measured at baseline, at 4 weeks, and at 8 weeks. After the intensified monitoring period, subjects resumed their usual monitoring. HbA1c was then measured at 24, 37, and 52 weeks. Multivariate linear regression was used to determine the effect of monitoring on glycemic control.
RESULTS—A total of 201 subjects completed the monitoring period. The baseline HbA1c (8.10 ± 1.67%) decreased during the monitoring period by 0.30 ± 0.68% (P < 0.001) at 4 weeks and by 0.36 ± 0.88% (P < 0.001) at 8 weeks. Although entry HbA1c and compliance independently predicted the week 8 HbA1c (r = 0.862, P < 0.001), standardized regression analysis found that compliance with the SMBG protocol influenced the week 8 HbA1c more than age, sex, BMI, exercise level, carbohydrate consumption, or treatment intensity at baseline. However, SMBG benefited only subjects whose testing compliance exceeded 75% or with an entry HbA1c >8.0%. Decreases in HbA1c (−0.31 ± 1.17%, P = 0.001) persisted in the 159 subjects followed for 52 weeks.
CONCLUSIONS—Intensified blood glucose monitoring improved glycemic control in a large cohort of stable, insulin-treated veterans with type 2 diabetes. SMBG provided a strong stimulus for improved self-care resulting in clinically important and sustained reductions in HbA1c.
Address correspondence and reprint requests to Richard M. Hoffman, MD, Albuquerque VA Medical Center 111GIM, 1501 San Pedro Dr. SE, Albuquerque, NM 87108. E-mail:.
Received for publication 13 December 2002 and accepted in revised form 24 February 2003.
W.C.D. is a paid consultant for and receives research support from Roche Diagnostics.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE