Self-monitoring of blood glucose (SMBG) is helpful in providing biofeedback to assess real-time effects of lifestyle changes. Increased SMBG frequency in patients with type 2 diabetes (T2D) and obesity during intensive weight management programs may be associated with better glycemic control and weight loss, according to study results published in BMJ Open Diabetes Research & Care.
Previous studies have reported conflicting results regarding the recommended SMBG frequency in patients with T2D who are not using insulin. There are limited data regarding the effect of SMBG on body weight and glycemic control during short-term weight management programs among patients with T2D and obesity.
The goal of this study was to assess the effect of SMBG frequency on body weight, glycemic control, and cardiovascular risk factors in patients with T2D and obesity during a 12-week intensive multidisciplinary weight management program.
The retrospective study included 42 of 63 adult patients (mean age, 57±9 years; 50% women) with T2D and obesity who were enrolled in the intensive multidisciplinary weight management program between May 2016 and April 2018 and who had complete SMBG data. The participants were divided into tertiles on the basis of average SMBG frequency over 12 weeks: lowest (mean SMBG frequency, 2.3 times/d; 14 patients), middle (mean SMBG frequency, 3.4 times/d; 14 patients), and highest (mean SMBG frequency, 5 times/d; 14 patients).
After 12 weeks, higher frequency of SMBG was associated with greater weight loss compared with lower SMBG frequency: median change in body weight was -10.4 kg (interquartile range [IQR], -7.6 to -14.4 kg) in the highest tertile, -8.3 kg (IQR, -5.2 to -12.2 kg) in the middle tertile, and -6.9 kg (IQR, -4.2 to -8.9 kg) in the lowest tertile (P =.018 for linear trend). The respective changes of body mass index were -3.9 kg/m2 (IQR, -2.8 to -4.9 kg/m2), -2.7 kg/m2 (IQR, -1.6 to -3.9 kg/m2), and -2.5 kg/m2 (IQR, -1.5 to -3.3 kg/m2) (P =.012 for linear trend).
Glycemic control according to glycated hemoglobin (HbA1c) improved more with greater frequency of SMBG: median change in HbA1c was -1.25% (IQR, -0.6% to -3.1%), -0.8% (IQR, -0.3% to -2%), and -0.5% (IQR, -0.2% to -1.2%) in the highest, middle, and lowest tertiles, respectively (P =.048 for linear trend). After adjusting for baseline HbA1c, the association between SMBG frequency and reduction in HbA1c reached statistical significance, indicating a confounding effect of baseline HbA1c on the magnitude of glycemic control improvement across the 12-week program.
There was no association between SMBG frequency and changes in blood pressure or lipid profile.
The study had several limitations, including the retrospective design, small sample size, and lack of a control group.
“These results suggest possible future recommendations for increasing SMBG frequency in patients with T2D during [intensive multidisciplinary weight management] to reach optimal outcomes,” concluded the researchers.
Tomah S, Mahmoud N, Mottalib A, et al. Frequency of self-monitoring of blood glucose in relation to weight loss and A1C during intensive multidisciplinary weight management in patients with type 2 diabetes and obesity. BMJ Open Diab Res Care. 2019;7(1):e000659.