SAT-146 Short-Term Optimization of Glucose Control Using Self-Monitored Blood Glucose and Standard Therapies

BACKGROUND Achieving diabetes control often takes months to years with intermittent clinic visits, infrequent changes in therapy and management by HbA1c levels. We conducted a study testing whether glucose control could be improved within 8 weeks by employing structured self-monitoring of blood glucose (SMBG), short-term follow-up with diabetes education and medication changes. METHODS 97 adults provided informed consent were screened and 78 completed the study. Participants had T1DM or T2DM, HbA1c ≥8%, and Cr <2.0 mg/dL. A CBC and sCr were done at the baseline visit, HbA1c at every visit. Patients were evaluated by a physician and CDE at each visit and treatment was adjusted to reach target blood glucose (90-120 mg/dl before meals, <180 mg/dl after meals) and to avoid hypoglycemia by one of the following methods: diabetes education, add or increase the dose of an oral anti-diabetic agent and add or change the dose of insulin according to standard treatment guidelines at baseline and weeks 2 and 4. Patients were provided with glucose meters and test strips, and were instructed to test 4x daily, complete a 7-point profile before visits 2, 4 and 8 and kept written glucose logs. . The mean HbA1c and mean glucose on the 7-point profile were compared using one-way repeated measure Analysis of Variance between baseline and subsequent visits RESULTS Of the 78 patients, 64.1% had T2DM, 50% were females and 72% were Caucasians. Mean age (±SD) was 51.3±11.1 years, the median (interquartile range) for diabetes duration was 9 (5-17) years and sCr was 0.85 (0.7-1.0) mg/dL. 53.9% had hypertension, 12.8% retinopathy, 17.9% neuropathy and 2.6% nephropathy. Anti-diabetes medications included metformin 39.7%, sulfonylureas 31.1%, thiazolidinediones 23.1%, insulin 58.9%, including 7.7% who used insulin pumps. The percentage of patients using insulin increased from 58.9% at baseline to 67.9% at week 8. The mean (±SD) HbA1C was 9.53% (1.71) at baseline, 9.10% (1.50) at week 2, 8.80% (1.37) at week 4 and 8.15% (1.19) at week 8, representing a decline of -0.39% from baseline to week 2 (CI -0.65 to -0.16, p<0.001); -0.33% (CI -0.56 to -0.09 p=0.002) from week 2 to week 4; -0.65% (CI -0.89 to -0.42 p<0.001) from week 4 to week 8 and -1.38% from baseline to week 8 (CI -1.62 to -0.14, p<0.001). The mean (±SD) glucose on the 7-point profile was 187.11 (52.60) mg/dL at week 2, 176.21 (48.96) mg/dL at week 4, 157.51 (5.73) mg/dL at week 8, it declining -26.02 mg/dL (CI -42.32 to 0.70, p=0.001) from week 2 to week 8. CONCLUSION An intensive glucose optimization program conducted in patients with poorly controlled diabetes was successful in reducing HbA1c over 8 weeks. Increased SMBG, diabetes education and conventional medication adjustments were the key drivers. This structured optimization method improves glucose control safely and rapidly, and may be useful in pre-operative patients and those with limited access to more advanced diabetes therapies.