Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study
Open accessAbstract
Aims/hypothesis The aim of this study was to obtain epidemiological data on self-monitoring of blood glucose (SMBG) in type 2 diabetes and to investigate the relationship of SMBG with disease-related morbidity and mortality.Methods The German multicentre Retrolective Study 'Self-monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes' (ROSSO) followed 3,268 patients from diagnosis of type 2 diabetes between 1995 and 1999 until the end of 2003. Endpoints were diabetes-related morbidity (non-fatal myocardial infarction, stroke, foot amputation, blindness or haemodialysis) and all-cause mortality. SMBG was defined as self-measurement of blood glucose for at least 1 year.Results During a mean follow-up period of 6.5 years, 1,479 patients (45.3%) began SMBG prior to an endpoint and an additional 64 patients started SMBG after a non-fatal endpoint. Interestingly, many patients used SMBG while being treated with diet or oral hypoglycaemic drugs (808 of 2,515, 32%). At baseline, the SMBG cohort had higher mean fasting blood glucose levels than the non-SMBG cohort (p<0.001), suggesting that insufficient metabolic control was one reason for initiating SMBG. This was associated with a higher rate of microvascular endpoints. However, the total rate of non-fatal events, micro- and macrovascular, was lower in the SMBG group than in the non-SMBG group (7.2 vs 10.4%, p=0.002). A similar difference was found for the rate of fatal events (2.7 vs 4.6%, p=0.004). Cox regression analysis identified SMBG as an independent predictor of morbidity and mortality, with adjusted hazard ratios of 0.68 (95% CI 0.51-0.91, p=0.009) and 0.49 (95% CI 0.31-0.78, p=0.003), respectively. A better outcome for both endpoints was also observed in the SMBG cohort when only those patients who were not receiving insulin were analysed.Conclusions/interpretation SMBG was associated with decreased diabetes-related morbidity and all-cause mortality in type 2 diabetes, and this association remained in a subgroup of patients who were not receiving insulin therapy. SMBG may be associated with a healthier lifestyle and/or better disease management.
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Cross-sectional and longitudinal observational studies in several countries have failed to show improvement in glycemic control associated with SMBG in type 2 diabetes.
“For individuals with type 2 diabetes, cross-sectional and longitudinal observational studies in several countries have failed to demonstrate an improvement in glycemic control (as measured by mean HbA 1c concentration) associated with the use of SMBG (102-104).”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [104]
Frequency of meter use did not predict HbA1c in type 2 diabetes.
“Frequency of meter use did not predict HbA 1c .”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [104]
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- Authors
- Martin, S., Schneider, B., Heinemann, L., Lodwig, V., Kurth, H.-J., Kolb, H., Scherbaum, W. A., & for the ROSSO Study Group
- Affiliations
- Deutsches Diabetes-Zentrum e.V. (DE)
- Medizinische Hochschule Hannover (DE)
- Profil Institute for Metabolic Research (DE)
- Institute for Medical Informatics and Biostatistics (CH)
- Corresponding author
- Martin, S.
- Venue
- Diabetologia
- Published
- 2005-12-17
- Volume
- 49
- Issue
- 2
- Pages
- 271-278
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2142280025
- Cited by
- 284
- References
- 40
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 8 · 2023: 7 · 2022: 8 · 2021: 5 · 2020: 11 · 2019: 11 · 2018: 6 · 2017: 16 · 2016: 7 · 2015: 13 · 2014: 19 · 2013: 13 · 2012: 21
- FWCI
- 14.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bundesministerium für Bildung und Forschung
- Bundesministerium für Gesundheit
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- self-monitoring of blood glucose, type 2 diabetes, all-cause mortality, microvascular complications, macrovascular complications, glycemic control, fasting blood glucose, insulin therapy, oral antidiabetic drugs, myocardial infarction, stroke, foot amputation, blindness
- MeSH terms
- Aged, Blood Glucose, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Hypoglycemic Agents, Insulin, Longitudinal Studies, Male, Middle Aged, Regression Analysis, Retrospective Studies, Blood Glucose Self-Monitoring, Cohort Studies, Survival Analysis, Outcome Assessment, Health Care, Disease Management, Diabetes Complications
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