Murata Glen H, Duckworth William C, Shah Jayendra H, Wendel Christopher S, Mohler M Jane, Hoffman Richard M
New Mexico VA Health Care System, Albuquerque, NM 87108, USA.
J Gen Intern Med. 2009 Jan;24(1):48-52. doi: 10.1007/s11606-008-0830-7. Epub 2008 Oct 31.
The value of self-monitoring blood glucose (SMBG) in type 2 diabetes is controversial.
To determine SMBG testing rates are positively associated with glycemic control in veterans on oral hypoglycemic agents (OHA).
Observational database study.
Southwestern Healthcare Network veterans taking OHA in 2002 and followed through the end of 2004.
OHA and glucose test strip (GTS) prescriptions were derived from pharmacy files. Subjects were categorized into five groups according to their end-of-study treatment status: group 1 (no medication changes), group 2 (increased doses of initial OHA), group 3 (started new OHA), group 4 (both OHA interventions), and group 5 (initiated insulin). We then used multiple linear regression analyses to examine the relationship between the SMBG testing rate and hemoglobin A1c (HbA1c) within each group.
We evaluated 5,862 patients with a mean follow-up duration of 798 +/- 94 days. Overall, 44.2% received GTS. Ultimately, 47% of subjects ended up in group 1, 21% in group 2, 9% in group 3, 8% in group 4, and 16% in group 5. A univariate analysis showed no association between the SMBG testing rate and HbA1c. However, after stratifying by group and adjusting for initial OHA dose, we found that more frequent testing was associated with a significantly lower HbA1c in groups 1, 4, and 5. The effect ranged from -0.22% to -0.94% for every ten GTS/week.
Higher SMBG testing rates were associated with lower HbA1c, but only when stratifying the analyses to control for treatment intensification.
2型糖尿病患者自我血糖监测（SMBG）的价值存在争议。
确定口服降糖药（OHA）治疗的退伍军人中，SMBG检测率与血糖控制呈正相关。
观察性数据库研究。
2002年服用OHA并随访至2004年底的西南医疗网络退伍军人。
OHA和血糖试纸（GTS）处方来自药房记录。根据研究结束时的治疗状态，将研究对象分为五组：第1组（未改变用药），第2组（增加初始OHA剂量），第3组（开始使用新的OHA），第4组（两种OHA干预措施），第5组（开始使用胰岛素）。然后，我们使用多元线性回归分析来检验每组中SMBG检测率与糖化血红蛋白（HbA1c）之间的关系。
我们评估了5862例患者，平均随访时间为798±94天。总体而言，44.2%的患者接受了GTS。最终，47%的研究对象归入第1组，21%归入第2组，9%归入第3组，8%归入第4组，16%归入第5组。单因素分析显示SMBG检测率与HbA1c之间无关联。然而，在按组分层并调整初始OHA剂量后，我们发现第1、4和5组中更频繁的检测与显著更低的HbA1c相关。每增加每周十次GTS检测，HbA1c降低范围为-0.22%至-0.94%。
更高的SMBG检测率与更低的HbA1c相关，但仅在分层分析以控制治疗强化时如此。
