SELF-MONITORING OF BLOOD-GLUCOSE UNDER IN TENSIVE INSULIN THERAPY - ACCEPTANCE AND IMPACT OF FREQUENT BLOOD-GLUCOSE MEASUREMENTS ON QUALITYOF GLYCEMIC CONTROL

In intensive insulin therapy frequent measurements of blood glucose ar e necessary for daily insulin adjustments. The aim of our study was to determine acceptance of frequent blood glucose measurements and its r elation to quality of glycemic control over a period of 5 years. We re port on 57 un selected patients with type 1 diabetes mellitus, who wer e at least half a year under intensive insulin therapy when entering t he study. Mean age was 34 +/- 9, diabetes duration 18 +/- 8 years. The number of daily blood glucose measurements, HbAlc, body mass index, d aily insulin dose, routine laboratory values, number of severe hypogly cemic reactions and frequency of retinopathy, nephropathy and neuropat hy were determined for year I and 5. We found an increase in daily blo od glucose measurements from 2.5 to 4.5 per day (year 1 resp. year 5). The frequency of blood glucose measurements at the begin of our study respectively after 5 years was: less than or equal to 2.0/day in 51% vs. 12%, > 2.0 but < 4.0/day in 20% vs. 21% and greater than or equal to 4.0/day in 29% vs. 67% of patients. HbAlc decreased from 7.3 +/- 1. 2 to 6.4 +/- 1.1% after 5 years (p < 0.001). A comparison of subgroups of patients showed that frequency of blood glucose measurement is not the only cause for this improvement, but adequate education of diabet ic patients seems to be most important. Retinopathy and neuropathy inc reased despite better diabetic control, 2 patients developed microalbu minuria, all other data determined at study entry remained unchanged a fter 5 years. We conclude that frequent daily blood glucose measuremen ts were accepted by the majority of our patients over a long period of time. Mean blood glucose determined by HbAlc improved under intensive insulin therapy. In our study group with low HbAlc values at baseline this effect was only partly related to the frequency of daily blood g lucose measurements.