{"title":"The influence of self-monitoring blood glucose frequency on the oscillation of hemoglobin A1c and chronic complications.","authors":"I-Chin Huang, Pei-Wen Wang, Rue-Tsuan Liu, Shih-Chen Tung, Jung-Fu Chen, Ming-Chun Kuo, Ching-Jung Hsieh","doi":"10.4103/2319-4170.106167","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>A fluctuating blood glucose level is one of the risks of chronic complications in diabetes. Previous studies indicated that hemoglobin A1c (HbA1c) values apparently improved after initiation of self-monitoring blood glucose (SMBG). The purpose of this study is to investigate the relationship between the frequency of SMBG, long-term fluctuatation of HbA1c, and risks of chronic complications in diabetes.</p><p><strong>Methods: </strong>We enrolled 1052 patients with type 2 diabetes. The mean follow-up was 4.7 years. The HbA1c level and frequency of SMBG were recorded every 3 months. Non-mydriatic retinal photography, semiquantitative neuropathy assessment, the lipid profile, serum creatinine level, and urine protein were measured at the beginning of the study and then every year. The fluctuation in HbA1c throughout the period was expressed as the standard deviations (SDs) of all measurements of the HbA1c.</p><p><strong>Results: </strong>The frequency of SMBG was significantly and negatively correlated with the SDs of the HbA1c (r = -0.553, p < 0.001) but not with the average HbA1c. After controlling for age, sex, body mass index, duration of diabetes and comorbidities (dyslipidemia and hypertension), the correlation was still apparent (r = -0.511, p = 0.008). Patients with progression of nephropathy, neuropathy, and retinopathy, exhibited greater fluctuation of HbA1cs (2.38 ± 0.99 vs. 0.93 ± 1.16, p-value 0.002; 0.97 ± 1.59 vs. 0.90 ± 0.56, p-value 0.04; 0.99 ± 1.33 vs. 0.90 ± 0.56, p-value 0.04, respectively) and less frequent SMBG (3.2 ± 2.6 vs. 4.3 ± 3.1, p-value 0.02; 3.2 ± 2.6 vs. 4.1 ± 3.9, p-value 0.05; 3.0 ± 3.1 vs. 4.2 ± 2.8, p-value 0.01, respectively) than patients without progression of these complications.</p><p><strong>Conclusion: </strong>This study shows that frequent SMBG decreased the fluctuation of HbA1c and decreased microvascular complications. Decreasing fluctuation of HbA1c may play an important role in diabetes treatment.</p>","PeriodicalId":10018,"journal":{"name":"Chang Gung medical journal","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"17","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chang Gung medical journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/2319-4170.106167","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 17
Abstract
Background: A fluctuating blood glucose level is one of the risks of chronic complications in diabetes. Previous studies indicated that hemoglobin A1c (HbA1c) values apparently improved after initiation of self-monitoring blood glucose (SMBG). The purpose of this study is to investigate the relationship between the frequency of SMBG, long-term fluctuatation of HbA1c, and risks of chronic complications in diabetes.
Methods: We enrolled 1052 patients with type 2 diabetes. The mean follow-up was 4.7 years. The HbA1c level and frequency of SMBG were recorded every 3 months. Non-mydriatic retinal photography, semiquantitative neuropathy assessment, the lipid profile, serum creatinine level, and urine protein were measured at the beginning of the study and then every year. The fluctuation in HbA1c throughout the period was expressed as the standard deviations (SDs) of all measurements of the HbA1c.
Results: The frequency of SMBG was significantly and negatively correlated with the SDs of the HbA1c (r = -0.553, p < 0.001) but not with the average HbA1c. After controlling for age, sex, body mass index, duration of diabetes and comorbidities (dyslipidemia and hypertension), the correlation was still apparent (r = -0.511, p = 0.008). Patients with progression of nephropathy, neuropathy, and retinopathy, exhibited greater fluctuation of HbA1cs (2.38 ± 0.99 vs. 0.93 ± 1.16, p-value 0.002; 0.97 ± 1.59 vs. 0.90 ± 0.56, p-value 0.04; 0.99 ± 1.33 vs. 0.90 ± 0.56, p-value 0.04, respectively) and less frequent SMBG (3.2 ± 2.6 vs. 4.3 ± 3.1, p-value 0.02; 3.2 ± 2.6 vs. 4.1 ± 3.9, p-value 0.05; 3.0 ± 3.1 vs. 4.2 ± 2.8, p-value 0.01, respectively) than patients without progression of these complications.
Conclusion: This study shows that frequent SMBG decreased the fluctuation of HbA1c and decreased microvascular complications. Decreasing fluctuation of HbA1c may play an important role in diabetes treatment.
背景:血糖水平波动是糖尿病慢性并发症的风险之一。既往研究表明，开始自我监测血糖(SMBG)后，血红蛋白A1c (HbA1c)值明显改善。本研究旨在探讨糖尿病患者SMBG频率、HbA1c长期波动与慢性并发症风险之间的关系。方法:我们招募了1052例2型糖尿病患者。平均随访时间为4.7年。每3个月记录一次HbA1c水平和SMBG频率。在研究开始时和每年测量无散光视网膜摄影、半定量神经病变评估、血脂、血清肌酐水平和尿蛋白。整个时间段内HbA1c的波动用所有HbA1c测量值的标准差(sd)表示。结果:SMBG频率与HbA1c SDs呈显著负相关(r = -0.553, p < 0.001)，与平均HbA1c无显著负相关。在控制年龄、性别、体重指数、糖尿病病程和合并症(血脂异常和高血压)后，相关性仍然很明显(r = -0.511, p = 0.008)。肾病、神经病变和视网膜病变进展的患者hba1c波动更大(2.38±0.99 vs 0.93±1.16,p值0.002;0.97±1.59 vs. 0.90±0.56,p值0.04;0.99±1.33 vs 0.90±0.56,p值分别为0.04)和较少发生SMBG(3.2±2.6 vs 4.3±3.1,p值为0.02;3.2±2.6 vs. 4.1±3.9,p值0.05;3.0±3.1 vs. 4.2±2.8,p值分别为0.01)。结论:本研究表明，频繁的SMBG降低了HbA1c的波动，减少了微血管并发症。降低HbA1c波动可能在糖尿病治疗中发挥重要作用。
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