Baseline results of a large ABACUS trial: association of a greater self-monitoring of blood glucose frequency with more frequent insulin boluses and lower HbA1c

Several studies on the management of diabetes have indicated the consideration of self-monitoring of blood glucose (SMBG to be essential to the management of patients with type 1 (T1DM) and type 2 (T2DM) diabetes on multiple daily insulin injection (MDI) therapy.

Moreover, even though previous studies had demonstrated an association between frequent SMBG and glycaemic control, Dr. R. Ziegler and coworkers performed the present a large, prospective, randomized, multi-national study, named Automated Bolus Advisor Control and Usability Study (ABACUS) that determined whether SMBG frequency had actually correlated with better clinical outcomes, by an examination of the baseline data of a large clinical trial.

For this study, researchers had collected the baseline data from a total of 219 T1DM and T2DM poorly controlled (HbA1c ≥ 7.5%/58 mmol/l) MDI-treated patients. Among these, 202 had T1DM and 17 had T2DM. All the enrollees had a mean (SD) age of 42.5 (14.1) years, mean BMI of 26.4 (4.4), and mean HbA1c of 8.85% (1.15).

As a part of this study protocol, the demographic data, daily insulin bolus dose, HbA1c values, and self-reported SMBG frequency were correlated.

The resulting findings from this study showed a mean (SD) frequency of self-reported SMBG was 4.29 (1.51) tests/day. Significantly similar frequency of SMBG was reported between T1DM and T2DM enrollees {4.34 (1.51) vs. 3.76 (1.35) times per day; p = ns}.

Similar SMBG frequency was reported among women and men {4.25 (1.24) vs. 4.33 (1.70) times per day; p = ns}. Lower mean (SD) frequency of SMBG was reported by enrollees who were aged <30 years of age when compared to those who were older {3.83 (1.72) vs. 4.44 (1.41); p < 0.01)}.

There were no correlations shown by the SMBG frequency with the following: education level, time from diagnosis to start of MDI, or length of time on MDI. Mean (SD) frequency of self-reported boluses within the cohort was 3.54 (0.93) per day, which was similar according to type of diabetes or gender.

Moreover, frequency of SMBG was associated with boluses (r = 0.44) but not with the total daily insulin bolus dose. There was also a significant correlation shown by SMBG with HbA1c (of r = -0.30), indicative of the association between a more frequent SMBG and a lower HbA1c, independently of the type of diabetes.

Based upon all the above findings this study indicated that SMBG was performed in patients treated with MDI therapy for an average of 4-5 times daily independently of type of diabetes, gender or education level; but less number of younger patients tended to be tested than by the older patients. Thus this study concluded that a greater SMBG frequency was associated with more frequent insulin boluses and lower HbA1c, and that a frequent SMBG, when utilized to manage MDI therapy actively, can lead to a more efficacious therapy and improve diabetes control.