Self-monitoring of blood glucose levels and glycemic control: The NorthernCalifornia Kaiser Permanente Diabetes Registry

PURPOSE: We sought to evaluate the effectiveness of self-monitoring blood g lucose levels to improve glycemic control. SUBJECTS AND METHODS: A cohort design was used to assess the relation betwe en self-monitoring frequency (1996 average daily glucometer strip utilizati on) and the first glycosylated hemoglobin (HbA(1c)) level measured in 1997, The study sample included 24,312 adult patients with diabetes who were mem bers of a large, group model, managed care organization. We estimated the d ifference between HbA(1c) levels in patients who self-monitored at frequenc ies recommended by the American Diabetes Association compared with those wh o monitored less frequently or not at A. Models were adjusted for age, sex, race, education, occupation, income, duration of diabetes, medication refi ll adherence, clinic appointment "no show" rate, annual eye exam attendance , use of nonpharmacological (diet and exercise) diabetes therapy, smoking, alcohol consumption, hospitalization and emergency room visits, and the num ber of daily insulin injections. RESULTS: Self-monitoring among patients with type 1 diabetes (greater than or equal to3 times daily) and pharmacologically treated type 2 diabetes (at least daily) was associated with lower HbA(1c) levels ( 1.0 percentage poi nts lower in type I diabetes and 0.6 points lower in type 2 diabetes) than was less frequent monitoring (P <0.0001). Although there are no specific re commendations for patients with nonpharmacologically treated type 2 diabete s, those who practiced self-monitoring (at any frequency) had a 0.4 point l ower HbA(1c) level than those not practicing at all (P <0.0001). CONCLUSION: More frequent self-monitoring of blood glucose levels was assoc iated with clinically and statistically better glycemic control regardless of diabetes type or therapy. These findings support the clinical recommenda tions suggested by the American Diabetes Association. <(c)> 2001 by Excerpt a Medica, Inc.