Intensified blood glucose monitoring improves glycemic control in stable, insulin-treated veterans with type 2 diabetes: The diabetes outcomes in veterans study (DOVES)

OBJECTIVE - To examine the effect of intensified self-monitored blood glucose (SMBG) testing on glycemic control. RESEARCH DESIGN AND METHODS - Subjects with stable, insulin-treated type 2 diabetes performed SMBG using an electronic blood glucose meter before all meals and at bedtime for 8 weeks. Baseline data were collected on demographics, clinical characteristics, diet, and exercise. HbA_1c was measured at baseline, at 4 weeks, and at 8 weeks. After the intensified monitoring period, subjects resumed their usual monitoring. HbA_1c was then measured at 24, 37, and 52 weeks. Multivariate linear regression was used to determine the effect of monitoring on glycemic control. RESULTS - A total of 201 subjects completed the monitoring period. The baseline HbA_1c (8.10 ± 1.67%) decreased during the monitoring period by 0.30 ± 0.68% (P < 0.001) at 4 weeks and by 0.36 ± 0.88% (P < 0.001) at 8 weeks. Although entry HbA_1c and compliance independently predicted the week 8 HbA_1c (r = 0.862, P < 0.001), standardized regression analysis found that compliance with the SMBG protocol influenced the week 8 HbA_1c more than age, sex, BMI, exercise level, carbohydrate consumption, or treatment intensity at baseline. However, SMBG benefited only subjects whose testing compliance exceeded 75% or with an entry HbA_1c >8.0%. Decreases in HbA_1c (-0.31 ± 1.17%, P = 0.001) persisted in the 159 subjects followed for 52 weeks. CONCLUSIONS - Intensified blood glucose monitoring improved glycemic control in a large cohort of stable, insulin-treated veterans with type 2 diabetes. SMBG provided a strong stimulus for improved self-care resulting in clinically important and sustained reductions in HbA_1c.