Page 12 - Glucose Monitoring Devices

The evidence base for SMBG in type 2 diabetes 7

Although the DCCT did not enroll children of 13 years old and younger,
it demonstrated higher HbA1c values both in the conventionally and intensively
treated adolescent cohort compared with adults, as well as more acute complica-
tions, such as ketoacidosis and severe hypoglycemia [43]. Several studies suggested
that frequent SMBG is associated with improved glycemic control and less acute
complications in youth with T1D. A prospective, 1-year study, which involved
300 subjects of 7e16 years old demonstrated that glycemic control improved signif-
icantly as the frequency of SMBG increased. The decrease from an HbA1c of
9.1%e8.0% has been shown between those measuring at most once per day and
those measuring 5 or more times per day. In addition, the incidence of hypoglycemia
and hospitalization rate was higher in those with the poorest glycemic control [54].
In the same way, the association between frequency of SMBG and glucose control
has been reported for adolescents [55], children visiting a diabetes camp [56] and
1 year following diagnosis of T1D [57]. Furthermore, analysis of the German/Aus-
trian Diabetes Patienten Verlaufsdokumentation (DPV) database of 26,723 children
and adolescents with T1D, aged 0e18 years, showeddafter adjustment for multiple
confoundersdthat more frequent SMBG was significantly associated with better
metabolic control, with a drop of HbA1c of 0.2% for one additional SMBG per
day and decreased rate of diabetes ketoacidosis. However, increasing the SMBG fre-
quency above five per day was associated with a decrease in average HbA1c only in
the group on CSII [58]. Age-dependent analysis from the DPV database across two
decades demonstrated an increase in the frequency of SMBG in all-age groups, both
in intensified conventional therapy and insulin pump users [59].

The evidence base for SMBG in type 2 diabetes
Similarly, SMBG was used in major clinical studies of people with type 2 diabetes
(T2D) for adaptation of treatment in intensive glycemic management. However, the
role of SMBG in optimal glycemic control and clinical outcomes is less clear in
T2D. In the UK Prospective Diabetes Study (UKPDS), improved blood glucose
control significantly decreased rates of microvascular complications and decreased
the progression of diabetic microvascular diseases in participants newly diagnosed
with T2D followed for 10 years [60]. In the prospective 6-year Kumamoto study,
intensive insulin therapy targeting both fasting and postprandial glucose effectively
delayed the onset and progression of diabetic microvascular complications with
almost comparable results to those in the DCCT [61]. Extended follow-up of the
UKPDS trial revealed the enduring effects of intensive glycemic control on micro-
vascular complications and long-term reductions in myocardial infarction and
all-cause mortality [62]. Conversely, results from randomized controlled trials
Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes
and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation, and Vet-
erans Affairs Diabetes Trial suggested the lack of significant reduction in cardiovas-
cular disease events with intensive glycemic control in T2D participants followed