title: Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry.
abstract: OBJECTIVE
  We sought to evaluate the effectiveness of self-monitoring blood glucose levels to improve glycemic control.
  
  
  METHODS
  A cohort design was used to assess the relation between self-monitoring frequency (1996 average daily glucometer strip utilization) and the first glycosylated hemoglobin (HbA1c) level measured in 1997. The study sample included 24,312 adult patients with diabetes who were members of a large, group model, managed care organization. We estimated the difference between HbA1c levels in patients who self-monitored at frequencies recommended by the American Diabetes Association compared with those who monitored less frequently or not at all. Models were adjusted for age, sex, race, education, occupation, income, duration of diabetes, medication refill adherence, clinic appointment "no show" rate, annual eye exam attendance, use of nonpharmacological (diet and exercise) diabetes therapy, smoking, alcohol consumption, hospitalization and emergency room visits, and the number of daily insulin injections.
  
  
  RESULTS
  Self-monitoring among patients with type 1 diabetes (> or = 3 times daily) and pharmacologically treated type 2 diabetes (at least daily) was associated with lower HbA1c levels (1.0 percentage points lower in type 1 diabetes and 0.6 points lower in type 2 diabetes) than was less frequent monitoring (P < 0.0001). Although there are no specific recommendations for patients with nonpharmacologically treated type 2 diabetes, those who practiced self-monitoring (at any frequency) had a 0.4 point lower HbA1c level than those not practicing at all (P < 0.0001).
  
  
  CONCLUSIONS
  More frequent self-monitoring of blood glucose levels was associated with clinically and statistically better glycemic control regardless of diabetes type or therapy. These findings support the clinical recommendations suggested by the American Diabetes Association.
authors.affiliation: Division of Research, Kaiser Permanente, Oakland, California, USA. ajk@dor.kaiser.org
authors.forename: A J
authors.initials: AJ
authors.lastname: Karter
authors.forename: L M
authors.initials: LM
authors.lastname: Ackerson
authors.forename: J A
authors.initials: JA
authors.lastname: Darbinian
authors.forename: R B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: A
authors.initials: A
authors.lastname: Ferrara
authors.forename: J
authors.initials: J
authors.lastname: Liu
authors.forename: J V
authors.initials: JV
authors.lastname: Selby
mesh_terms: D000328:Adult; D000368:Aged; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D002140:California; D003920:Diabetes Mellitus / Q000097:blood* / Q000178:diet therapy / Q000188:drug therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control*; D007003:Hypoglycemia / Q000097:blood / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D012042:Registries; D013997:Time Factors; D014481:United States
chemical_list: D006442:Glycated Hemoglobin