Επίκουρος Καθηγητής Νικόλαος Τεντολούρης (Επιβλέπων), Καθηγητής Απόστολος Μπουρνέτας, Διευθυντής ΕΣΥ Σταύρος Παππάς
Diabetes can be called an emerging epidemic all over the world. Individuals
with diabetes, both type 1 and type 2, are at great risk to develop
microvascular and macrovascular complications. The UKPDS study and other
controlled clinical trials have demonstrated that improved control of blood
glucose reduces the risk of diabetic complications. Despite the use of new
drugs for the treatment of diabetes and the increased knowledge about the
disease, the overall glycaemic control has not improved. Self-monitoring of
blood glucose can be a valuable tool for the achievement of glycaemic goals,
mainly for patients with diabetes mellitus type 1 and insulin treated diabetes
mellitus type 2. For diabetes mellitus type 2 patients, treated with oral
antidiabetic treatment, the significance of self-monitoring of blood glucose
has not been established yet. In all cases effective implementation of
self-monitoring of blood glucose requires patient’s adherence and education,
and also frequent communication with his doctor. Patients should know their own
glycaemic goals, and how to interpret and use the data gained from
self-monitoring of blood glucose, in order to adjust medication dosage, food
intake, and physical activity and also to prevent hypoglycaemia.
Recommendations for the frequency and the timing of self-monitoring of blood
glucose must be specific. Self-monitoring of blood glucose provides information
in real time, so it is a useful tool for both patients and doctors. It can
complement HbA1c in overall management programs for diabetes.
The existing literature data, in our country, are limited. For that reason the
present study was conducted in order to investigate the relationship between
self-monitoring of blood glucose and achievement of glycaemic control in
subjects with type 2 diabetes as well as factor affecting subject’s behavior
regarding self-monitoring of blood glucose.
We examined 776 subjects with type 2 diabetes (412 males / 364 females, mean
age: 68.83 ± 10.26 years), ΒΜΙ 31.45 ± 5.98 Kg/m2 , duration of diabetes
16.57 ± 8.06 years and HbA1c 7.31 ± 3.45%. 74.9% of study participants had
arterial hypertension, 74.0% dyslipidemia, 22.4% coronary artery disease, 18.7%
retinopathy, 7.0% chronic renal disease and 5.9% peripheral neuropathy. 59.4%
was on oral antidiabetic treatment and 40.6% was on insulin therapy alone or in
combination with oral antidiabetic treatment. Hypoglycaemia was reported by
27.80% of study participants.
Study participants reported 6 (0-32) monitoring of plasma glucose per week and
23.5 (0-125) monitoring of plasma glucose per month. For subjects on oral
antidiabetic treatment the numbers were, respectively: 4 (0-24) monitoring of
plasma glucose per week and 12 (0-123) monitoring of plasma glucose per month.
For subjects on insulin treatment the numbers were, respectively: 8 (0-32)
monitoring of plasma glucose per week and 30 (0-125) monitoring of plasma
glucose per month. The number of monitoring of plasma glucose was significant
different between subjects on oral antidiabetic treatment compared to subjects
on insulin treatment (Ρ<0,001).
Univariate linear regression analysis showed significant relationships between
monitoring of plasma glucose and duration of diabetes (P<0.001), dyslipidemia
(Ρ=0.005), retinopathy (P<0.001), chronic renal disease (P=0.001), coronary
artery disease (P<0.001), insulin therapy (P<0.001) and hypoglycaemia
(P<0.001). No significant relationships were found with gender, age, body mass
index, arterial hypertension, neuropathy, HbA1c and oral antidiabetic
treatment. Multivariate analysis demonstrated that retinopathy, insulin
therapy, hypoglycaemia and dyslipidemia were constantly and independently
associated with monitoring of plasma glucose.
In conclusion, this study has shown that self-monitoring of plasma glucose is
statistically related to retinopathy, insulin therapy, hypoglycaemia and
dyslipidemia in subjects with type 2 diabetes. However, univariate analysis
failed to show any significant relationship between self- monitoring of plasma
glucose and glycaemic control.
self-monitoring, diabetes mellitus type 2, hypoglycemia, insulin