Relationship between metabolic control and self-monitoring of blood glucose in insulin-treated patients with diabetes mellitus

ObjectiveTo assess the relationship between metabolic control (MC) and frequency of self-monitoring of blood glucose (SMBG) in insulin-treated patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus, and to analyze the factors associated to MC.Materials and methodsA multicenter, cross-sectional, observational study was conducted in which endocrinologists enrolled diabetic patients treated with insulin who used a glucometer. The cut-off value for MC was HbA1c ≤ 7%. Grade of acceptance of the glucometer was assessed using a visual analogue scale (VAS).ResultsA total of 341 patients (53.5% males) with a mean age (SD) 52.8 (16.3) years, mean HbA1c of 7.69% (1.25) and 128 (37.5%) with T1DM and 211 (61.9%) with T2DM were evaluable. SMBG was done by 86.1% at least once weekly. No relationship was seen between MC and SMBG (p = 0.678) in the overall sample or in the T1DM (p = 0.940) or T2DM (p = 0.343) subgroups. In the logistic regression model, hyperglycemic episodes (Exp-b [risk] 1.794, p = 0.022), falsely elevated HbA1c values (Exp-b 3.182, p = 0.005), and VAS (Exp-b 1.269, p = 0.008) were associated to poor MC in the total sample. Hyperglycemic episodes (Exp-b 2.538, p = 0.004), falsely elevated HbA1c values (Exp-b 3.125, p = 0.012), and VAS (Exp-b 1.316, p = 0.026) were associated to poor MC in the T2DM subgroup, while body mass index (Exp-b 1.143, p = 0.046) was associated to poor MC in the T1DM subgroup.ConclusionsIn this retrospective, non-controlled study on patients with DM treated with insulin who used a glucometer, no relationship was seen between the degree of metabolic control and frequency of use of the glucometer.

ResumenObjetivoEvaluar la relación entre el grado de control metabólico (CM) y la frecuencia de la automonitorización de la glucemia capilar (AGC) en pacientes con diabetes mellitus (DM) tipo 1 (DM1) y 2 (DM2) tratados con insulina, y analizar factores asociados al CM.Material y métodosEstudio observacional multicéntrico transversal en el que endocrinólogos incluyeron a pacientes con DM tratados con insulina que utilizaban un glucómetro. El punto de corte para definir un CM fue una HbA1c ≤ 7% y no control > 7%. Se valoró en una escala analógica visual (EAV) el grado de aceptación del glucómetro.ResultadosFueron evaluables 341 pacientes (53,5% varones), con una edad media ± DE de 52,8 ± 16,3 años, HbA1c media de 7,69 ± 1,25%, 128 (37,5%) con DM1 y 211 (61,9%) con DM2. El 86,1% de los pacientes utilizaron el glucómetro al menos una vez en la semana. No se observó ninguna relación entre el CM y la AGC ni en la muestra total (p = 0,678), ni en DM1 (p = 0,940) ni DM2 (p = 0,343). En el modelo de regresión logística, se asociaron a un mal CM en la muestra total y en DM2 los episodios de hiperglucemias (Exp-b [riesgo] 1,794, p = 0,022, y Exp-b 2,538, p = 0,004, respectivamente), las concentraciones de HbA1c falsamente elevadas (Exp-b 3,182 p = 0,005, y Exp-b 3,125, p = 0,012), y la EAV (Exp-b 1,269, p = 0,008, y Exp-b 1,316, p = 0,026), y en la DM1 el índice de masa corporal (Exp-b 1,143, p = 0,046).ConclusionesEn este estudio observacional no controlado en pacientes con DM tratados con insulina que utilizan un glucómetro no se observa ninguna relación entre el grado de CM y la frecuencia de su uso en el último mes.