Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .
A structured self-monitoring of blood glucose approach in type 2 diabetes encourages more frequent, intensive, and effective physician interventions: results from the STeP study.
BACKGROUND 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 . METHODS The Structured Testing Program ( STeP ) study was a cluster-r and omized , multicenter trial with 483 poorly controlled , insulin-naive T2DM subjects . Primary care practice s were r and omized 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 . RESULTS 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 . CONCLUSIONS 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
Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .