title: The impact of structured blood glucose testing on attitudes toward self-management among poorly controlled, insulin-naïve patients with type 2 diabetes.
abstract: BACKGROUND
  Patients with T2DM often view self-monitoring of blood glucose (SMBG) as burdensome and pointless, which may affect their broader attitudes toward diabetes management. We examined how a structured SMBG protocol influenced diabetes self-efficacy and autonomous motivation over time, and linked these to changes in glycemic control.
  
  
  METHODS
  The Structured Testing Program (STeP) is a 12-month, two-arm, cluster-randomized trial that assessed the efficacy of structured SMBG in 483 insulin-naïve T2DM patients. Measures included: Confidence in Diabetes Self-Care for Type 2 patients (CIDS-T2), Diabetes-related Autonomous Motivation (DRAM), self-management behaviors and HbA1c.
  
  
  RESULTS
  Intent-to-treat (ITT) and per-protocol (PP) analyses showed significant increases in CIDS-T2 scores over time (main effects p<0.0001). PP analysis showed significant between-group differences (p<0.05), with adherent STG patients displaying greater CIDS-T2 improvement than ACG patients. PP analyses showed main and between-group effects in DRAM with similar findings. Changes in CIDS-T2 were related to HbA1c changes over time; no self-management variable mediated this relationship. CIDS-T2 and HbA1c displayed a significant time-concordant relationship.
  
  
  CONCLUSIONS
  Structured SMBG leads to significant increases in self-confidence and autonomous motivation associated with diabetes self-management. Changes in self-confidence are linked to changes in glycemic control and share a time-concordant relationship.
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Fisher
authors.forename: William H
authors.initials: WH
authors.lastname: Polonsky
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Parkin
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Jelsovsky
authors.forename: Bettina
authors.initials: B
authors.lastname: Petersen
authors.forename: Robin S
authors.initials: RS
authors.lastname: Wagner
mesh_terms: D000368:Aged; D015190:Blood Glucose Self-Monitoring / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology*; D019468:Disease Management; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000523:psychology*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin