Effectiveness of postprandial versus preprandial home blood glucose monitoring on glycemic control in insulin treated type 2 diabetes mellitus

Abstract

BACKGROUND AND RATIONALD: Evidence for the benefits of glucose self-monitoring, especially in type 2 diabetics, is lacking. OBJECTIVES: To evaluate the effect of self-monitored blood glucose testing and to compare pre-and postprandial strategies in assessing glycemic control RESEARCH DESIGN AND METHODS: Subjects with stable insulin-treated type 2 diabetes monitored blood glucose seven times daily (pre/postbreakfast, pre/postlunch, pre/postdinner, and bedtime) for 2 weeks. They were then randomized to either pre-or postprandial monitoring group, with 4 times finger blood glucose measurement daily and insulin dosage self-adjustment, for 8 weeks, followed by an eight-week period of flexible monitoring program by measuring finger bolood glucose at anytime of the day with the frequency of 7-28 times/week The fasting plasma glucose (FPG), fructosamine and HbA1c were measured at 8th and 16th weeks. The self-monitoring records were evaluated for the number tests, mean plasma glucose, number of hypoglycemic (<55 mg/dl) and hyperglycemic (>280 mg/dl) readings captured at the various testing times. RESULTS: A total of 75 subjects completed the study protocol; their average age was 62.3+3.8 years, 66% were women, and the mean HbA1 c at baseline was 8.0+_1.8%. There were significant improvements in mean FPG and HbA1c levels in both groups at 8th and 16th week. No significant difference in fructosamine and HbA1c between pre-and post-prandial strategies was observed. (P=0.12). However, weight gain, insulin dosage, and hyperglycemic readings were greater in post-prandial strategy, whereas hypoglycemic readings were greater in pre-prandial strategy. Combination of pre-and post-prandial monitoring further improved glycemic control with less number of hypo- and hyperglycemic readings at 16th week. CONCLUSION: Self-monitoring for insulin treated type 2 diabetes improved glycemic control and lessen the episodes of hypoglycemia and hyperglycemia if a person's diet, activity and medications are adjusted based on the monitoring results. No significant difference between pre- and post-prandial monitoring strategies was observed. Combination of both leads to a better outcome.