Innovative diabetes management concept can significantly reduce HbA1c values, improve glycemic control

Feb 2 2011

An innovative diabetes management concept including structured self-monitoring of blood glucose (SMBG), data visualization, pattern analysis and derived therapy adjustments can significantly reduce HbA1c values, improve glycemic control and enhance patients' quality of life. These are the key findings of the 12-month data from the Structured Testing Protocol (STeP) Study, newly published in Diabetes Care.

Self-monitoring of blood glucose (SMBG) is a well-established element of therapy management for people with type 1 or type 2 diabetes on insulin therapy. However, there have been controversial views on the question of whether regular SMBG is similarly beneficial for non-insulin treated people with type 2 diabetes. To gain new insights on this subject, the STeP Study was performed: A prospective, cluster-randomized, multi-center clinical trial, which examined the impact of structured SMBG upon glycemic control in 483 non-insulin treated people with type 2 diabetes who evidenced poor glycemic control (HbA1c greater than or equal to 7.5%) at baseline. The results provide new and significant evidence on its effectiveness.

The study design - usual diabetes care vs. structured diabetes management

Participants were recruited from various primary care practices across the eastern United States. Practices were randomly assigned to an active control group.

Analysis of individual blood glucose profiles – key to effective structured diabetes management

The innovative concept is based on structured 7-point blood glucose profiles (fasting, preprandial and 2hour postprandial at each meal, and bedtime), collected and documented over 3 consecutive days prior to each scheduled quarterly healthcare professional visit. To document blood glucose values, meal sizes and energy levels, and to comment on their SMBG experiences, STG participants used the Accu-Chek® 360 Degree View 3-day profile tool. They discussed the obtained profiles with their caregivers at all medical visits. To familiarize them with the protocol, patients in the STG arm of the study received a standardized training in SMBG and pattern analysis, while their doctors were equally trained and equipped with an algorithm suggesting appropriate medication strategies.

Significantly reduced HbA1c values with use of structured diabetes management

Intent-to-treat (ITT) analysis showed significant improvements in mean HbA1c values for patients in both the ACG and STG. After 12 months, however, HbA1c values were significantly lower for STG patients than for ACG participants.

Meaningful test results for better therapy adjustments and glycemic control

The use of the structured and effective diabetes management concept with the individual pattern analysis, as applied in the STG arm of the study with the Accu-Chek 360 Degree View 3-day profile tool, can lead to substantially improved medical outcomes in poorly-controlled non-insulin treated people with type 2 diabetes, which are clinically meaningful. Since the STG protocol puts emphasis on when patients test and how healthcare professionals make clinically relevant use of this data supported by the Accu-Chek tools of Roche Diabetes Care, it may be appropriate to pay particular attention to increased SMBG quality and to how test results are used. Integrating structured SMBG into a collaborative program of care and hence the therapy routines of non-insulin treated people with type 2 diabetes can therefore lead to an improved doctor-patient interaction, supporting informed therapy adjustments and resulting in a better glycemic control.