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A Randomized Controlled Trial

Elaine C. Moreland, MD; Lisa K. Volkening, BA; Margaret T. Lawlor, MS, CDE; Karen A. Chalmers, MS, RD, CDE; Barbara J. Anderson, PhD; Lori M. B. Laffel, MD, MPH

Arch Intern Med. 2006;166:689-695.

Background  Frequent blood glucose (BG) monitoring is a critical component of diabetes management, yet many barriers exist to consistent monitoring.

Methods  In this randomized controlled trial, we sought to determine if an educational manual, the Blood Sugar Monitoring Owner's Manual (BGMOM), could increase adherence to BG monitoring by helping patients form realistic expectations and responses to BG monitoring results. The 199 participants were recruited from a multidisciplinary diabetes clinic and had high-risk diabetes (hemoglobin A_1C 8.0%); 35% had type 1 diabetes mellitus. Participants were randomized to 1 of 3 groups: BGMOM intervention (BGM+), attention control (BG meter only [MT]), or standard care (SC). The BGM+ and MT groups received BG meters and meter education; the BGM+ group also received BGMOM booklets. The SC group received usual care. Data gathered during 6 months of follow-up included BG monitoring frequency and hemoglobin A_1C measurement.

Results  Monitoring frequency increased significantly in the BGM+ group (1.9 ± 1.3 to 2.8 ± 1.5 times daily, P<.001) but only slightly in the MT group (1.7 ± 1.3 to 2.0 ± 1.3 times daily). The BGM+ group experienced the greatest improvement in hemoglobin A_1C level (BGM+: –0.13 ± 1.28; MT: –0.04 ± 1.31; SC: 0.04 ± 1.10). Further, a higher percentage of those in the BGM+ group (61%) improved their glycemic control compared with the other groups (44%; P = .05). Finally, the BGM+ group displayed the most knowledge about the definition of hemoglobin A_1C (P = .04) and reported the least amount of negative affect about out-of-range BG monitoring results (P = .03).

Conclusion  As an adjunct to standard diabetes education and support, a manual such as the BGMOM can help optimize BG monitoring and glycemic control.

Author Affiliations: Sections on Genetics and Epidemiology and Behavioral and Mental Health, Joslin Diabetes Center, Boston, Mass. Dr Anderson is currently with the Department of Pediatrics, Endocrinology and Metabolism Section, Baylor College of Medicine, Houston, Tex. Dr Moreland is currently with the Department of Pediatrics, Division of Pediatric Endocrinology, University of Alabama, Birmingham.

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