A single-center, open, comparative study of the effect of using self-monitoring of blood glucose to guide therapy on preclinical atherosclerotic markers in type 2 diabetic subjects.
BACKGROUND
The aim of our study was to determine the effect of treatment based on preprandial and postprandial self-monitoring of blood glucose (SMBG) on the progression of carotid intima-medial thickness (CIMT) in noninsulin-treated type 2 diabetes mellitus (T2DM) subjects.


METHODS
In this 18-month prospective trial, we recruited subjects 18-70 years of age, treated with metformin and sulfonylurea, with a standardized hemoglobin A1c (HbA1c) level < or =9.0%. Subjects were randomized to use of fasting/preprandial (FP) SMBG results to adjust evening medication or use of postprandial (PP) SMBG results to adjust morning medication. The primary end point was change in CIMT; change in HbA1c was a secondary end point.


RESULTS
Of the 300 subjects randomized, 280 (140 in each group) completed all biochemical tests and CIMT analysis. Carotid intima-medial thickness was reduced significantly in PP subjects from 0.78 (+/-0.15) mm to 0.73 (+/-0.14) mm (p < 0.005), but no significant CIMT reduction was seen in FP subjects. A significant reduction in HbA1c was also seen in the PP group (p < 0.005) but not in the FP group 1 (p = 0.165). Significant improvements in body mass index (p = 0.038), waist circumference (p < 0.001), systolic blood pressure (p = 0.008), and serum cholesterol (p = 0.02) were also seen in PP subjects but not in FP subjects.


CONCLUSIONS
Use of postprandial SMBG data to adjust therapy was associated with a significant regression of carotid intima-medial thickening and a reduction in HbA1c in T2DM, whereas no significant improvement in these parameters was seen in subjects who used fasting/preprandial SMBG data for therapy adjustment.
Mohan
Viswanathan
V
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases, International Diabetes Federation Centre of Education, Gopalapuram, Chennai, India. drmohans@vsnl.net
Ravikumar
Radhakrishnan
R
Poongothai
Subramani
S
Amutha
Anandakumar
A
Sowmya
Santhamma
S
Karkhuzali
Kulasegaran
K
Parkin
Christopher G
CG
D000293:Adolescent; D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000209:etiology* / Q000628:therapy*; D015415:Biomarkers; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D002339:Carotid Arteries / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D010349:Patient Compliance; D019518:Postprandial Period; D011446:Prospective Studies; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D055815:Young Adult
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D013453:Sulfonylurea Compounds