SELF-MONITORING OF BLOOD-GLUCOSE AND INSULIN DOSE ALTERATION IN TYPE-1 DIABETES-MELLITUS

The purpose of this study was to evaluate the relationship between pro per use of self-monitoring of blood glucose (SMBG) including knowledge and application of specific algorithms and metabolic control in a gro up of randomly selected insulin-dependent diabetic patients. We studie d 80 patients responding to the following criteria: intensive conventi onal insulin therapy and SMBG for at least 6 months using a reflectanc e meter, and previous 5-day hospital education period. The practical k nowledge of the guidelines was evaluated by a questionnaire simulating 8 metabolic situations. A computer analysis of the SMBG data for the 3 months preceding the study allowed us to evaluate patient compliance with SMBG (number of blood glucose determinations) and patients' appl ication of the guidelines (percentage of insulin doses modified accord ing to the guidelines). Fifty-nine patients (79%) were compliant with SMBG and had better metabolic control than the non-compliers (HbA1c: 6 .7 +/- 1.1% vs. 7.5 +/- 1.9, P < 0.05). Twenty-eight out of the 59 com pliant subjects had good knowledge of the guidelines but without paten t improvement of glycemic control. Seventeen of these 28 correctly use d the algorithms to modify insulin dosage; their HbA1c levels were low er than those of the 11 patients who did not use the algorithms (6.1 /- 0.9 vs. 7.1 +/- 0.9%, P < 0.05). The percentage of insulin dose mod ification consistent with the guidelines and the level of HbA,, was ne gatively correlated in the good-knowledge group. The conclusion is tha t good metabolic control is linked not only with the degree of knowled ge but also with the application of this knowledge.