Anna Elisabeth Minder1, Dominique Albrecht1, Juliane Schäfer2, Henryk Zulewski3. 1. Division of Endocrinology Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. 2. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031 Basel, Switzerland; Clinical Trial Unit, University Hospital Basel, Schanzenstrasse 55, 4031 Basel, Switzerland. 3. Division of Endocrinology Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. Electronic address: Henryk.zulewski@unibas.ch.
Abstract
AIMS: Self-monitored blood glucose (SMBG) and knowledge of insulin requirements are pivotal for good metabolic control in patients with diabetes mellitus type 1. However, the SMBG-frequency needed for optimal glycaemic control especially in well educated patients is unclear. METHODS: In patients with type 1 diabetes treated with flexible intensified insulin therapy, we evaluated HbA1c values and the directly preceding computerised SMBG-frequencies over a 12 months period. To estimate the association between HbA1c and SMBG-frequency, we fitted a piecewise linear spline model with a change in slope at 4 SMBGs per day which is the recommended minimal SMBG-frequency at our institution. RESULTS: A total of 150 patients were available for analysis, with a median baseline HbA1c of 7.1% (interquartile range 6.6, 7.8). In the multivariable analysis (adjusted for gender and psychological problems), each additional SMBG measurement was associated with an estimated difference in HbA1c of -0.19% (95% confidence interval (CI) -0.42, 0.05) for ≤4 SMBGs per day and of -0.02% (95% CI -0.10, 0.06) for >4 SMBGs per day. CONCLUSIONS: Good diabetes control can be achieved in routine diabetes care with flexible intensified insulin therapy based on continuing patients' education and with a minimum of 4 SMBGs per day.
AIMS: Self-monitored blood glucose (SMBG) and knowledge of insulin requirements are pivotal for good metabolic control in patients with diabetes mellitus type 1. However, the SMBG-frequency needed for optimal glycaemic control especially in well educated patients is unclear. METHODS: In patients with type 1 diabetes treated with flexible intensified insulin therapy, we evaluated HbA1c values and the directly preceding computerised SMBG-frequencies over a 12 months period. To estimate the association between HbA1c and SMBG-frequency, we fitted a piecewise linear spline model with a change in slope at 4 SMBGs per day which is the recommended minimal SMBG-frequency at our institution. RESULTS: A total of 150 patients were available for analysis, with a median baseline HbA1c of 7.1% (interquartile range 6.6, 7.8). In the multivariable analysis (adjusted for gender and psychological problems), each additional SMBG measurement was associated with an estimated difference in HbA1c of -0.19% (95% confidence interval (CI) -0.42, 0.05) for ≤4 SMBGs per day and of -0.02% (95% CI -0.10, 0.06) for >4 SMBGs per day. CONCLUSIONS: Good diabetes control can be achieved in routine diabetes care with flexible intensified insulin therapy based on continuing patients' education and with a minimum of 4 SMBGs per day.
Authors: Nelson Chow; Daniel Shearer; Jessica Aydin Plaa; Betty Pottinger; Monika Pawlowska; Adam White; Hugh D Tildesley Journal: BMJ Open Diabetes Res Care Date: 2016-04-29