Introduction
Diabetes prevalence continues to rise globally for all age groups as researchers projected the number of patients with diabetes to double from 171 to 366 million between the years 2000 and 2030.1 The parallel rapid increase in prevalence of obesity in Western societies further complicates the situation where nearly 87.5% of patients with type 2 diabetes (T2D) are either overweight or obese.2 Interventional studies in patients with combined T2D and obesity have shown that dietary intervention and increased physical activity can lead to weight reduction and significant improvements in glycemic control. Currently, lifestyle modifications and nutrition therapy are recommended as the first-line treatment for T2D.3 4 However, patient adherence to lifestyle changes is a major challenge in real-world clinical practice. Lifestyle modifications are particularly difficult to achieve in many patients without accompanying real-time biofeedback to keep them motivated. Self-monitoring of blood glucose (SMBG) was introduced in 1971 and has been a valuable tool for providing feedback on glycemic control.5 SMBG revolutionized diabetes management, particularly in patients treated with intensive insulin therapy (IIT), requiring them to test 6–10 (or more) times per day.6–9 Such high frequency of SMBG in patients with type 1 diabetes on IIT was shown to be associated with a greater reduction in A1C and lower incidence of complications.4 6 10 While the American Diabetes Association emphasizes the importance of frequent SMBG in patients on IIT, it clearly states the lack of evidence on clinical utility of specific SMBG frequency in patients with T2D treated with oral antihyperglycemic agents and/or basal insulins.8
Several randomized controlled trials (RCT) debated the utility of frequent SMBG in non-insulin-treated patients with T2D. It was suggested that integrating feedback from SMBG into clinical and lifestyle decisions may help in achieving glycemic targets in these patients.8 A meta-analysis of 15 RCTs showed that in non-insulin-treated patients with T2D, the use of SMBG was associated with greater reduction in A1C compared with non-SMBG.11 Bosi et al found that use of a structured SMBG plan led to improved glycemic control among non-insulin-treated patients with T2D compared with patients who did not follow a structured SMBG plan.12 A more recent meta-analysis concluded that using structured SMBG data to adjust diabetes medications was tied to greater A1C reduction in non-insulin-treated patients with T2D.13 Although Martin et al showed that use of SMBG was associated with lower event rates of stroke and myocardial infarction among patients with T2D compared with non-SMBG users, blood pressure and lipid profile were not different in SMBG users compared with non-SMBG users.14 Therefore, data are lacking on whether more frequent SMBG has any impact on body weight, glycemic control, and cardiovascular disease (CVD) risk factors during short-term intensive multidisciplinary weight management (IMWM) programs in real-world clinical practice among patients with T2D and obesity.8 15–19
We aimed to investigate the relationship between frequency of SMBG and changes in body weight, glycemic control, and CVD risk factors in patients with T2D and obesity enrolled in an IMWM program.