University of California, San Diego, and Behavioral Diabetes Institute, San Diego, California, USA.
Diabetes Technol Ther. 2011 Aug;13(8):797-802. doi: 10.1089/dia.2011.0073. Epub 2011 May 13.
We evaluated how a structured patient/physician self-monitoring of blood glucose (SMBG) intervention influenced the timing, frequency, and effectiveness of primary care physicians' treatment changes with type 2 diabetes mellitus (T2DM) patients over 12 months.
The Structured Testing Program (STeP) study was a cluster-randomized, multicenter trial with 483 poorly controlled, insulin-naive T2DM subjects. Primary care practices were randomized to the Active Control Group (ACG) or the Structured Testing Group (STG), the latter of which included quarterly review of structured SMBG results. STG patients used a paper tool that graphs seven-point glucose profiles over 3 consecutive days; physicians received a treatment algorithm based on SMBG patterns. Impact of structured SMBG on physician treatment modification recommendations (TMRs) and glycemic outcomes was examined.
More STG than ACG patients received a TMR at each study visit (P < 0.0001). Of patients who received at least one TMR, STG patients demonstrated a greater reduction in glycated hemoglobin A1c (HbA1c) than ACG patients (-1.2% vs. -0.8%, P < 0.03). Patients with a baseline HbA1c ≥8.5% who received a TMR at the Month 1 visit experienced greater reductions in HbA1c (P = 0.002) than patients without an initial TMR. More STG than ACG patients were started on incretins (P < 0.01) and on thiazolidinediones (P = 0.004). The number of visits with a TMR was unrelated to HbA1c change over time.
Patient-provided SMBG data contribute to glycemic improvement when blood glucose patterns are easy to detect, and well-trained physicians take timely action. Collaborative use of structured SMBG data leads to earlier, more frequent, and more effective TMRs for poorly controlled, non-insulin-treated T2DM subjects.
我们评估了结构化的患者/医生自我监测血糖（SMBG）干预如何影响初级保健医生在 12 个月内治疗 2 型糖尿病（T2DM）患者的时间、频率和效果。
结构化测试计划（STeP）研究是一项多中心、集群随机对照试验，纳入了 483 例血糖控制不佳、未使用胰岛素的 T2DM 患者。将初级保健诊所随机分为主动对照组（ACG）或结构化测试组（STG），后者每季度对结构化 SMBG 结果进行审查。STG 患者使用一种图表化连续 3 天 7 点血糖谱的纸质工具；医生根据 SMBG 模式获得治疗算法。研究考察了结构化 SMBG 对医生治疗修改建议（TMR）和血糖结果的影响。
在每个研究访视中，STG 患者比 ACG 患者接受 TMR 的比例更高（P < 0.0001）。在接受至少一次 TMR 的患者中，STG 患者的糖化血红蛋白 A1c（HbA1c）降低幅度大于 ACG 患者（-1.2%对-0.8%，P < 0.03）。在第 1 个月就诊时接受 TMR 的基线 HbA1c≥8.5%的患者，HbA1c 降低幅度更大（P = 0.002），而初始无 TMR 的患者则无此效果。与 ACG 患者相比，更多的 STG 患者开始使用肠促胰岛素（P < 0.01）和噻唑烷二酮类药物（P = 0.004）。TMR 次数与随时间变化的 HbA1c 变化无关。
当血糖模式易于检测且训练有素的医生及时采取行动时，患者提供的 SMBG 数据有助于改善血糖。结构化 SMBG 数据的协作使用可使血糖控制不佳、未接受胰岛素治疗的 T2DM 患者更早、更频繁、更有效地接受 TMR。
