Does availability of reliable home blood glucose data at diabetes appointments improve glycemia?

To establish the prevalence of reliable self-monitored blood glucose (r-SMBG) data at office visits for diabetes and to determine whether r-SMBG is associated with changes in glycemic control and other clinical parameters.

We conducted a chart review of 500 patients followed in an Endocrinology Faculty/Commercial Insurance Practice (FP) or a Managed Medicare/Medicaid Diabetes Clinic (MDC). Follow-up visits for patients with type 1 or type 2 diabetes from January 1, 2012 to June 30, 2012 were analyzed for anthropometric data, creatinine (Cr), glomerular filtration rate (GFR), low-density lipoprotein cholesterol (LDL-C), medications, hemoglobin A1C (A1C), change in A1C from the previous visit (ΔA1C), and availability of r-SMBG data at the visit.

Our sample was composed of 215 MDC patients (43%) and 285 FP patients (57%). Overall, 151 patients (30%) provided r-SMBG data at their visit, with no difference between MDC or FP patients. Mean A1C at MDC was 9.1%, while mean A1C at FP was 7.9% (P<.001). MDC patients with A1C >8.0% demonstrated an A1C reduction of 1.2% if they provided r-SMBG, compared to an increase of 0.1% for MDC patients who did not (P<.05). Providing r-SMBG did not affect A1C in FP patients in any A1C range.

Only a minority of diabetes patients, mostly insulin-treated, made r-SMBG data available to their providers. Insulin-requiring Managed Medicare/Medicaid patients with poorly controlled diabetes had an A1c reduction associated with r-SMBG. Prospective studies are needed to determine whether this patient population may be more likely to benefit from r-SMBG at their visits.