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

OBJECTIVE - The role of self-monitoring of blood glucose (SMBG) in type 2 d iabetes is still a matter of debate. in the framework of a nationwide outco mes research program, we investigated the frequency of SMBG and its associa tion 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 gen eral practitioners. Patients completed a questionnaire investigating SMBG p ractice and QoL (diabetes-related stress, diabetes health distress, diabete s-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 the ir blood glucose levels at home I time per day, 899 patients (31%) tested t heir blood glucose levels : I time per week, and 414 patients (14%) tested their blood whereas 1,071 patients (38%) stated that the never practiced SM BG. A higher frequency of SMBG was associated with better, metabolic contro l among subjects who were able to adjust insulin doses, whereas no relation ship was found in all other patients, irrespective of the kind of treatment . Multivariate analyses showed that an SMBG Frequency ! 1 Lime 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 educationa l strategy devoted to the promotion of patient autonomy. In patients not tr eated with insulin, self-monitoring is associated with higher HbA(1c) level s and psychological burden. Our data do not support the extension of SMBG t o this group.