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Abstract

Objective: Self-monitoring blood glucose (SMBG) is frequently recommended, beside its controversial efficacy. Herein, it was aimed to evaluate frequency of SMBG and its efficacy among patients with type 2 diabetes (T2DM) in primary care settings in Düzce Province of Turkey. Methods: The cross-sectional and primary care-based study enrolled a total of 680 patients with T2DM treated with oral anti-diabetic agents. Status of SMBG was recorded as non-use, daily, weekly and monthly. Metabolic and glycemic indexes were compared according to statuses of SMBG use. Results: Over the two-third of the patients were user of SMBG. The frequency of daily, weekly and monthly use of SMBG was 13.2%, 32.1% and 24.5%, respectively. Of them, the majority have irregularly used SMBG (59.4%). However, the ratio of patients who have regularly used SMBG was just 24.3%. No significant difference was observed between statuses of SMBG in glycemic indexes of HbA1c, Fasting blood glucose and post-prandial blood glucose (p=0.655, p=0.721 and p=0.389). Conclusions: Although the high and irregular use of SMBG, there was no difference between status of SMBG. Therefore, the family physicians should consciously advice self-monitoring blood glucose. It should be recommended after the patients are competent and empowered with education for its use. Further investigations should be carried out to general idea on clinical effectiveness SMBG in Turkey

Keywords

• Type 2 Diabetes Mellitus, Primary Care, Self-Monitoring Blood

Düzce İlinde İnsülin Kullanmayan Tip 2 Diyabet Hastalarında Kendi Kendine Kan Şekeri İzleminin Klinik Etkinliğinin Değerlendirilmesi: Birinci Basamak Tabanlı Bir Çalışma

Abstract

Amaç: Kendi kendine kan şekeri (SMBG) takibi sıklıkla tavsiye edilmesinin yanında, etkinliği tartışmalıdır. Burada, SMBG kullanımının diyabetteki sıklığını ve Türkiye’de Düzce ilinde birinci basamakta tip 2 diyabet (T2DM) olan hastalarda etkinliğinin değerlendirilmesi amaçlanmıştır. Yöntem: Kesitsel ve birinci basamak-tabanlı çalışmaya oral anti-diyabetik ajanlar ile tedavi olan T2DM'li toplam 680 hasta alınmıştır. SMBG kullanım durumu kullanmayan, günlük, haftalık ve aylık kullanan seklinde kaydedilmiştir. Metabolik ve glisemik indeksler SMBG kullanım durumuna göre karşılaştırılmıştır. Bulgular: Hastaların 2/3 ten fazlası SMBG uygulamaktadır. Günlük, haftalık ve aylık SMBG kullananların oranı sırası ile 13,2%, 32,1% ve 24,5% idi. Bunların da çoğunluğu düzensiz kullanıyordu (59,4%). Fakat düzenle kullananların oranı 24,3%. SMBG kullanım durum grupları arasında HbA1c, Açlık kan şekeri ve tokluk kan şekeri olan glisemik indeksler için farklılık gözlenmemiştir (Sırası ile p=0.655, p=0.721 ve p=0.389). Sonuç: Yüksek ve düzensiz SMBG kullanımı olsa da, SMBG kullanım durumları arasında hiçbir fark yoktu. Bu nedenle, aile hekimleri kendi kendine kan şekeri izlemini dikkatli ve bilinçli olarak tavsiye etmelidir. Hastalar eğitimle bilgilendirilmiş ve kendi yeterliliklerini kazanmasından sonra SMBG kullanımı önerilmelidir. Türkiye'de SMBG kullanımının klinik etkinliği hakkında genel bir kannat için ileri düzeyde araştırmalar yapılmalıdır

Keywords

• Tip 2 Diyabetes Mellitus, Birinci Basamak, Kendi Kendine

References

1. Urger RH, Foster DW. Diabetes mellitus. In: Wilson, JD, Foster, DW, Kronenserg, HM, Larson PR (Eds.). Williams’s Text Book of Endocrinology. Philadelphia: WB Saunders, 2001; 973–60.
2. Wild SG, Roglic A, Green R, King H. Global prevalence of diabetes. Estimated for the year 2000 and projection for 2030. Diabetes Care 2004; 27(5): 1047-54.
3. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of Diabetes Mellitus and Diabetes-related complications. Phys Ther 2008; 88(11): 1254-64.
4. Ripsin CM, Kang H, Urban RJ. Management of Blood Glucose in Type 2 Diabetes Mellitus. Am Fam Physician 2009; 79(1): 29-36.
5. Stratton IM, Adler AI, Neil HAW, et al. Association of glycemia with macrovascular and microvascular complications of type 2 diabetes (UKODS 35): prospective observational study. BMJ 2000; 321(7258): 405- 12.
6. The effect of intensive treatment of diabetes on the development and progression of long –term complications in insulin-dependent diabetes mellitus: The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993; 329(14): 977-86.
7. Harris MI. Health Care and health status and outcomes for patients with type 2 diabetes. Diabetes Care 2000; 23(6): 754-58.
8. Klein R, Klein BE, Moss SE, Cruickshanks KJ. Relation of hyperglycemia to the long term incidence and progression of diabetic retinopathy. Arch Intern Med 1994; 154(19): 2169-78.

9. Szymborska-Kajenek A, Psurek A, Hese Robert, Strojek K. Self-monitoring of blood glucose in treatment of type 2 diabetes. Diabetes Res Clin Pract 2009; 86 Suppl 1:S49-52.
10. Nauck MA, El-Ouaghlidi A, Vardarli I. Self-monitoring of Blood Glucose in Diabetes Mellitus. Dtsch Arztebl Int 2009; 106(37): 587-94.
11. Pollock RF, Valentina WJ, Goodall G, Brandle M. Evaluating the cost-effectiveness of self-monitoring of blood glucose in type 2 diabetes patients on oral anti-diabetic agents. Swiss Med Wkly 2010: 140:w13103.
12. Harris MI; National Health and Nutrition Examination Survey (NHANES III). Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Diabetes Care 2001; 24(6):979- 82.
13. Towfigh A, Romanova M, Weinreb JE, et al. Self-montoring of blood glucose levels in patients with type 2 diabetes mellitus not taking insulin: A meta-analysis. Am J Manag Care 2008; 14(7): 468-75.
14. Lecomte P, Romon I, Fosse S, Simon D, Fagot-Campagna A. Self-monitoring of blood glucose in people with type 1and 2 diabetes living in France: The Entred Study 2001. Diabetes & Metabolism 2008; 34(3): 219-26.
15. Baltaci D, Kutlucan A, Ozturk S, et al. Effectiveness for self-monitoring of blood sugar on blood glucose control in Turkish patients with type 2 diabetes mellitus. Med Glas (Zenica) 2012; 9(2): 211-7.
16. O’Kane MJ, Bunting B, Copeland M, Coates VE. Efficacy of self-monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomized controlled trial. BMJ 2008; 336(7654): 1174-7.
17. Malanda UL, Welschen LM, Riphagen II, Dekker JM, Nijpels G, Bot SD. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev. 2012; 1: CD005060. doi: 10.1002/14651858.CD005060.
18. Clar C, Barnard K, Cummins E, Royle P, Waugh N; Aberdeen Health Technology Assessment Group. Self- monitoring of blood glucose in type 2 diabetes: systematic review. Health Technol Assess. 2010; 14(12): 1- 140.
19. Welschen LMC, Bloemendal E, Nijpels G, et al. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin (review). Cochrane Database Syst Rev 2005; 18: CD005060.
20. Murata GH, Shah JH, Hoffman RM, et al. Intensified Blood Glucose Monitoring Improves Glycemic Control in Stable, Insulin–Treated Veterans with Type 2 Diabetes (DOVES). Diabetes Care 2003; 26(6): 1759-62.
21. Peel E, Parry O, Douglas M, Lawton J. Blood glucose self-monitoring in non-insulin-treated type 2 diabetes: a qualitative study of patients’ perspective. Br J Gen Pract 2004; 54(500): 183-8.
22. Martin S, Schneider B, Heinemann L, et al. Self-monitoring of blood glucose in type 2 diabetes and long term outcomes: an epidemiological cohort study. Diabetologia 2006; 49(2): 271-78.
23. Self-monitoring of blood glucose (Consensus Statement). American Diabetes Association. Diabetes care 1997; 19: 63-6.
24. TUIK, Population of Provinces by years, 2007-2013. http://www.tuik.gov.tr/UstMenu.do?metod=temelist. Accessed January 2011.
25. TURDEP-II sonuçları. http://www.turkendokrin.org/files/file/TURDEP_II_2011.pdf. Accessed January 2011.
26. Meier JL, Swislocki LM, Lopez JR et al. reduction in self-monitoring of blood glucose in person with type 2 diabetes results in cost saving and no change in glycemic control .A J Manag Care 2002; 8(6): 557-65.
27. Bajkowska-Fiedziukeiwicz A, Cypryk K, Kozdraj T, Mikolajczyk-Swatko A, Kosinski M, Jozefowska M. Self-monitoring of blood glucose and treatment outcomes in type 2 diabetic patients. Po Arch Med Wewn 2008; 118(5): 267-72.
28. Davis WA, Bruce DG, Davis TME. Is self-monitoring of blood glucose appropriate for all type 2 diabetic patients. Diabetes Care 2006; 29(8):1764-70.
29. Schwedes U, Siebolds M, Mertes G. Meal-related structured self-monitoring of blood glucose. Diabetes Care 2002; 25(11):1928-32.
30. Franciosi M, Pellegrini F, Berardis G, et al. The Impact of Blood Glucose Self-Monitoring on Metabolic Control and Quality of Life in Type 2 Diabetic Patients. Diabetes Care 2001; 24(11): 1870-7.
31. Simon J, Gray A, Clarke P, wade A, Neil A, Farmer A. Cost-effectiveness of self-monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial. BMJ 2008; 336(7654):1177-9.
32. Guerci B, Grange V, Bougneres P, et al. Self-monitoring of blood glucose significantly improves metabolic control in patients with type 2 diabetes mellitus: The Auto-Surveillance Intervention (ASIA) study. Diabetes Metab 2003; 29(6): 587-94.
33. Lim S, Kim DJ, Jeong In-K, et al. A Nationwide Survey about the Current Status of Glycemic Control and Complications in Diabetic Patients in 2006- The Committee of the Korean Diabetes Association on the Epidemiology of Diabetes Mellitus. Korean Diabetes J 2009; 33:48-57.
34. American Diabetes Association. Clinical practice recommendations. Executive summary: standards of medical care in diabetes – 2010. Diabetes Care 2010; 33(suppl 1):S4-S10.
35. Ginde AA, Espinola JA, Camargo CA Jr. Trends and disparities in U.S. emergency department visits for hypoglycemia, 1993-2005. Diabetes Care 2008; 31(3): 511-13.
36. Amiel SA, Dixon T, Mann R, et al. Hypoglycaemia in type 2 diabetes. Diabet Med 2008; 25(3): 245-54.
37. Davis WA, Beruce DG, Davis TM. Does self-monitoring of blood glucose improve outcome in type 2 diabetes? The Fremantle Diabetes Study. Diabetologia 2007; 50(3): 510-5.