Randomized trial of technology-assisted self-monitoring of blood glucose by low-income seniors: Improved glycemic control in type 2 diabetes mellitus
Abstract
Self-monitoring of blood glucose (SMBG) has been recommended for people with type 2 diabetes mellitus. This trial tested an automated self-management monitor (ASMM) that reminds patients to perform SMBG, provides feedback on results of SMBG, and action tips for improved self-management. This delayed-start trial randomized participants to using the ASMM immediately (IG), or following a delay of 6 months (DG). Glycated hemoglobin (HgbA1c) level and survey data was collected at home visits every 3 months. 44 diabetic men and women, mean age 70, completed the 12-month trial. Baseline HgbA1c was 8.1 % ± 1.0, dropping to 7.3 ± 1.0 by 9 months, with a 3-month lag in the DG (F = 3.56, p = 0.004). Decrease in HgbA1c was significantly correlated to increased frequency of SMBG, R = 0.588, p < 0.01. Providing older diabetics with objective immediate contingent feedback resulted in more frequent SMBG that correlated with better glycemic control. This type of technology may provide real-time feedback not only to patient users, but to the health care system, allowing better integration of provider recommendations with patient-centered action.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Most reviewed studies relied on cross-sectional data or short-term interventions.
“Most studies relied on cross-sectional data or short-term interventions [28,33], which are insufficient for evaluating the long-term impact of behavioral strategies on glycemic control or health outcomes [4,12].”
From Methodological Approaches in Studying Type-2 Diabetes-Related Health Behaviors—A Systematic Review (2025) · cites this paper as [28]
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Self-efficacy: Toward a unifying theory of behavioral change
Bandura, A. (1977) · Psychological Review · doi:10.1037/0033-295x.84.2.191 · Cited by 43,925 · see citing works
(1993) · New England Journal of Medicine · doi:10.1056/nejm199309303291401 · Cited by 24,667 · see citing works
Self-efficacy: Toward a unifying theory of behavioral change
Bandura, A. (1978) · Advances in Behaviour Research and Therapy · doi:10.1016/0146-6402(78)90002-4 · Cited by 10,586 · see citing works
Turner, R. C., Fox, C., Matthews, McElroy, H. H., Cull, C. A., Holman, R. R., Neil, P., Hadden, D. R., Wright, D., Manley, E., et al. (1998) · The Lancet · Cited by 8,419 · see citing works
Gupta, A., & Uribarri, J. (2016) · Hormone Research in Paediatrics · doi:10.1159/000444053 · Cited by 4,019 · see citing works
Harris, M. I., Flegal, K. M., Cowie, C. C., Eberhardt, M. S., Goldstein, D. E., Little, R. R., Wiedmeyer, H.-M., & Byrd-Holt, D. D. (1998) · Diabetes Care · doi:10.2337/diacare.21.4.518 · Cited by 2,703 · see citing works
Screening for Depression in the Older Adult
Irwin, M. R., Artin, K. H., & Oxman, M. N. (1999) · Archives of Internal Medicine · doi:10.1001/archinte.159.15.1701 · Cited by 1,220 · see citing works
Behavior Modification: Principles and Procedures
Miltenberger, R. G. (1996) · Cited by 1,011 · see citing works
Fear of hypoglycemia: quantification, validation, and utilization
Cox, D. J., Irvine, A., Gonder-Frederick, L., Nowacek, G., & Butterfield, J. (1987) · Diabetes Care · doi:10.2337/diacare.10.5.617 · Cited by 579 · see citing works
Farmer, A., Wade, A., Goyder, E., Yudkin, P., French, D., Craven, A., Holman, R., Kinmonth, A.-L., & Neil, A. (2007) · BMJ · doi:10.1136/bmj.39247.447431.be · Cited by 407 · see citing works
Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin
Malanda, U. L., Welschen, L. M., Riphagen, I. I., Dekker, J. M., Nijpels, G., & Bot, S. D. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005060.pub3 · Cited by 358 · see citing works
O’Kane, M. J., Bunting, B., Copeland, M., & Coates, V. E. (2008) · BMJ · doi:10.1136/bmj.39534.571644.be · Cited by 326 · see citing works
Guerci, B., Drouin, P., Grangé, V, Bougnères, P., Fontaine, P., Kerlan, V, Passa, P., Thivolet, C., Vialettes, B., & Charbonnel, B. (2003) · Diabetes & Metabolism · doi:10.1016/s1262-3636(07)70073-3 · Cited by 287 · see citing works
Establishment of Blood Glucose Monitoring System Using the Internet
Kwon, H., Cho, J., Kim, H., Song, B.-R., Ko, S., Lee, J., Kim, S., Chang, S., Kim, H., Cha, B., et al. (2004) · Diabetes Care · doi:10.2337/diacare.27.2.478 · Cited by 197 · see citing works
Talbot, F., Nouwen, A., Gingras, J., Gosselin, M., & Audet, J. (1997) · Journal of Behavioral Medicine · doi:10.1023/a:1025508928696 · Cited by 187 · see citing works
King, A. C., Friedman, R. H., Marcus, B. H., Castro, C. M., Napolitano, M. A., Ahn, D. K., & Baker, L. (2007) · Health Psychology · doi:10.1037/0278-6133.26.6.718 · Cited by 137 · see citing works
Tschanz, J. T., Welsh-Bohmer, K. A., Plassman, B. L., Norton, M. C., Wyse, B. W., & Breitner, J. C. S. (2002) · PubMed · Cited by 117 · see citing works
Does Patient Blood Glucose Monitoring Improve Diabetes Control?
McAndrew, L. M., Schneider, S. H., Burns, E. A., & Leventhal, H. (2007) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721707309807 · Cited by 109 · see citing works
Misconceptions About Diabetes and Its Management Among Low-Income Minorities With Diabetes
Mann, D. M., Ponieman, D., Leventhal, H., & Halm, E. A. (2009) · Diabetes Care · doi:10.2337/dc08-1837 · Cited by 84 · see citing works
Rutten, G. E. H. M., van Eijk, J. T. M., de Nobel, E., BEEK, M., & van der Velden, H. (1990) · Family Practice · doi:10.1093/fampra/7.4.273 · Cited by 65 · see citing works
Kleefstra, N., Ubink-Veltmaat, L. J., Houweling, S. T., Groenier, K. H., Jong, B. M., & Bilo, H. J. G. (2005) · PubMed · Cited by 55 · see citing works
Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin
Welschen, L. M., Bloemendal, E., Nijpels, G., Dekker, J. M., Heine, R. J., Stalman, W. A., & Bouter, L. M. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005060.pub2 · Cited by 51 · see citing works
(2001) · PsycEXTRA Dataset · doi:10.1037/e548192006-001 · Cited by 23 · see citing works
Self monitoring of blood glucose in type 2 diabetes
Heller, S. R. (2007) · BMJ · doi:10.1136/bmj.39276.549109.47 · Cited by 15 · see citing works
Flagged first, then by citations
1 of the 27 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Leventhal, H., Phillips, L. A., & Burns, E. (2016) · Journal of Behavioral Medicine · doi:10.1007/s10865-016-9782-2 · Cited by 1,350 · see citing works
The Handbook of Behavior Change
Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N. E., & Lintunen, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318 · Cited by 420 · see citing works
Changing Behavior Using the Theory of Planned Behavior
Ajzen, I., & Schmidt, P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.002 · Cited by 303 · see citing works
Changing Behavior Using the Model of Action Phases
Keller, L., Gollwitzer, P. M., & Sheeran, P. (2020) · The Handbook of Behavior Change · doi:10.1017/9781108677318.006 · Cited by 147 · see citing works
Changing Behavior Using the Health Action Process Approach
Schwarzer, R., & Hamilton, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.007 · Cited by 107 · see citing works
Gardner, B., Rebar, A. L., & Lally, P. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.041 · Cited by 69 · see citing works
Changing Behavior Using Social Cognitive Theory
Łuszczyńska, A., & Schwarzer, R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.003 · Cited by 71 · see citing works
Warner, L. M., & French, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.032 · Cited by 53 · see citing works
Changing Behavior Using Ecological Models
Salmon, J., Hesketh, K. D., Arundell, L., Downing, K. L., & Biddle, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.017 · Cited by 51 · see citing works
Fotteler, M. L., Mühlbauer, V., Brefka, S., Mayer, S., Kohn, B., Holl, F., Swoboda, W., Gaugisch, P., Risch, B., Denkinger, M., et al. (2022) · JMIR Aging · doi:10.2196/31916 · Cited by 52 · see citing works
Changing Behavior Using Self-Determination Theory
Hagger, M. S., Hankonen, N. E., Chatzisarantis, N. L. D., & Ryan, R. M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.008 · Cited by 49 · see citing works
Planning and Implementation Intention Interventions
Rhodes, R. E., Grant, S. J., & de Bruijn, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.039 · Cited by 41 · see citing works
Attitudes and Persuasive Communication Interventions
Hamilton, K., & Johnson, B. T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.031 · Cited by 40 · see citing works
Changing Behavior Using Habit Theory
Orbell, S., & Verplanken, B. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.013 · Cited by 39 · see citing works
Changing Behavior: A Theory- and Evidence-Based Approach
Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N. E., & Lintunen, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.001 · Cited by 39 · see citing works
Tarrant, M., Haslam, C., Carter, M., Calitri, R., & Haslam, S. A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.044 · Cited by 37 · see citing works
Changing Behavior Using Integrated Theories
Hagger, M. S., & Hamilton, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.015 · Cited by 39 · see citing works
Changing Behavior Using the Transtheoretical Model
DiClemente, C. C., & Graydon, M. M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.010 · Cited by 31 · see citing works
Changing Behavior Using the Health Belief Model and Protection Motivation Theory
Orbell, S., Zahid, H., & Henderson, C. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.004 · Cited by 32 · see citing works
Changing Behavior by Changing Environments
Marteau, T. M., Fletcher, P. C., Hollands, G. J., & Munafo, M. R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.014 · Cited by 27 · see citing works
Design, Implementation, and Evaluation of Behavior Change Interventions: A Ten-Task Guide
Abraham, C., & Denford, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.019 · Cited by 26 · see citing works
Changing Behavior Using the Reflective-Impulsive Model
Deutsch, R., & Strack, F. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.012 · Cited by 28 · see citing works
Dyadic Behavior Change Interventions
Scholz, U., Berli, C., Lüscher, J., & Knoll, N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.043 · Cited by 23 · see citing works
Developing Behavior Change Interventions
Hankonen, N. E., & Hardeman, W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.021 · Cited by 26 · see citing works
Rothman, A. J., Klein, W. M. P., & Sheeran, P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.020 · Cited by 25 · see citing works
Imagery, Visualization, and Mental Simulation Interventions
Hagger, M. S., & Conroy, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.033 · Cited by 22 · see citing works
Changing Behavior Using the Common-Sense Model of Self-Regulation
Cameron, L. D., Fleszar‐Pavlović, S. E., & Khachikian, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.005 · Cited by 23 · see citing works
Engagement of Stakeholders in the Design, Evaluation, and Implementation of Complex Interventions
Hudson, J. L., Moon, Z., Hughes, L. D., & Moss-Morris, R. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.024 · Cited by 20 · see citing works
Uri Gneezy, B., Kajackaite, A., & Meier, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.036 · Cited by 20 · see citing works
Ruiter, R. A. C., Crutzen, R., de Leeuw, E., & Kok, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.018 · Cited by 17 · see citing works
Zeng, Y., Wu, J., Han, Y., Chen, F., Chen, L., Yang, S., & Fang, Y. (2018) · Journal of Diabetes · doi:10.1111/1753-0407.12651 · Cited by 18 · see citing works
Changing Behavior Using Social Identity Processes
Reynolds, K. J., Branscombe, N. R., Subašić, E., & Willis, L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.016 · Cited by 17 · see citing works
Zacher, M. L., Wang, J., & Short, S. E. (2021) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbab022 · Cited by 14 · see citing works
Webb, T. L., & de Bruin, M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.037 · Cited by 14 · see citing works
Critical and Qualitative Approaches to Behavior Change
Chamberlain, K., & Lyons, A. C. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.030 · Cited by 12 · see citing works
Emerging Research and Development in Technology-based Self-monitoring
Bruhn, A. L., & Wills, H. P. (2018) · Advances in learning and behavioral disabilities · doi:10.1108/s0735-004x20180000030005 · Cited by 12 · see citing works
Maximizing User Engagement with Behavior Change Interventions
Yardley, L., Morrison, L. G., Müller, I., & Bradbury, K. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.025 · Cited by 11 · see citing works
The Science of Behavior Change: The Road Ahead
Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N. E., & Lintunen, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.046 · Cited by 11 · see citing works
Autonomy-Supportive Interventions
Reeve, J., & Cheon, S. H. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.035 · Cited by 9 · see citing works
Implementation Science and Translation in Behavior Change
Łuszczyńska, A., Łobczowska, K., & Horodyska, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.023 · Cited by 9 · see citing works
Treatment adherence and illness self-management: introduction to the special issue
Howren, M. B., & Gonzalez, J. S. (2016) · Journal of Behavioral Medicine · doi:10.1007/s10865-016-9804-0 · Cited by 9 · see citing works
de Ridder, D. T. D., Gillebaart, M., & Friese, M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.040 · Cited by 9 · see citing works
Epton, T., & Armitage, C. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.038 · Cited by 8 · see citing works
A Randomized Control Trial on the Effects of MoBeGo, a Self-Monitoring App for Challenging Behavior
Bruhn, A. L., Wehby, J. H., Hoffman, L., Estrapala, S., Rila, A., Hancock, E. M., Camp, A. V., Sheaffer, A. W., & Copeland, B. A. (2022) · Behavioral Disorders · doi:10.1177/01987429221093987 · Cited by 8 · see citing works
Evaluation of Behavior Change Interventions
Matthews, L., & Simpson, S. A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.022 · Cited by 7 · see citing works
Motivational Interviewing Interventions
Berman, A. H., Beckman, M., & Lindqvist, H. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.045 · Cited by 7 · see citing works
Commonsense Modeling (CSM) of Health Behaviors
Leventhal, H., Phillips, L. A., Burns, E. A., & Herold, J. (2020) · The Wiley Encyclopedia of Health Psychology · doi:10.1002/9781119057840.ch81 · Cited by 7 · see citing works
Economic and Behavioral Economic Approaches to Behavior Change
Brown, P. M., Cameron, L. D., Wilkinson, M., & Taylor, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.042 · Cited by 6 · see citing works
Changing Behavior Using Integrative Self-Control Theory
Hofmann, W., Dohle, S., & Diel, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.011 · Cited by 6 · see citing works
Conner, M. T., Williams, D. M., & Rhodes, R. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.034 · Cited by 6 · see citing works
Addressing Underserved Populations and Disparities in Behavior Change
Schüz, B., & Hooper, M. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.027 · Cited by 5 · see citing works
Changing Behavior in the Digital Age
Kavanagh, D. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.029 · Cited by 4 · see citing works
Methodological Approaches in Studying Type-2 Diabetes-Related Health Behaviors—A Systematic Review
Khandoker, F., & Grigsby, T. J. (2025) · Applied Sciences · doi:10.3390/app151910567 · Cited by 2 · see citing works
The Behavior of Self-Monitoring of Blood Glucose and Glycemic Control in Taiwanese Population
Lu, C., Tseng, C., Liao, K. C.-W., Yang, H.-J., Chen, P., & Perng, M. (2022) · Endocrines · doi:10.3390/endocrines3020019 · Cited by 2 · see citing works
Integration of Wearable Smart Sensor for Improving e-Healthcare
Thayananthan, V., & Basuhail, A. A. (2017) · International Journal of Advanced Computer Science and Applications · doi:10.14569/ijacsa.2017.081251 · Cited by 2 · see citing works
Changing Behavior Using Control Theory
Mansell, W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.009 · Cited by 2 · see citing works
Behavior Change in Community Contexts
Trickett, E. J., & Paterson, S. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.028 · Cited by 2 · see citing works
Cost-Effectiveness Evaluations of Behavior Change Interventions
Wang, T., Downes, M., Byrnes, J., & Scuffham, P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.026 · Cited by 1 · see citing works
Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N. E., & Lintunen, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.047
Ji, S., Tao, Y., Liu, J., Li, Y., Wen, Z., Wang, H., & 张先庚 (2026) · Journal of Visualized Experiments · doi:10.3791/70983
Wang, J., Li, C., Yang, Y., Bhandari, B., & Coleman, D. C. (2026) · The Science of Diabetes Self-Management and Care · doi:10.1177/26350106261438832
The doxastic relevance of imagination in the common sense model of illness representations
Brecevic, C. (2026) · Synthese · doi:10.1007/s11229-026-05715-6
- Authors
- Levine, J. C., Burns, E., Whittle, J., Fleming, R., Knudson, P., Flax, S., & Leventhal, H.
- Affiliations
- University of Toledo (US)
- Medical College of Wisconsin (US)
- University of Wisconsin–Milwaukee (US)
- FlexTech Systems (United States) (US)
- Rutgers, The State University of New Jersey (US)
- Corresponding author
- Levine, Jason C.
- Venue
- Journal of Behavioral Medicine
- Published
- 2016-07-01
- Volume
- 39
- Issue
- 6
- Pages
- 1001-1008
- ISSN
- 0160-7715 (ISSN-L)
- 1573-3521
- OpenAlex
- W2466269479
- Cited by
- 62
- References
- 27
- Citations by year
- 2026: 3 · 2025: 1 · 2022: 3 · 2021: 1 · 2020: 49 · 2018: 2 · 2017: 1 · 2016: 2
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (R44 AG019528-02)
- Agency for Healthcare Research and Quality (R18 HS17276-01)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- self-monitoring of blood glucose, type 2 diabetes, glycemic control, HbA1c, contingent feedback, older adults, low-income elderly, diabetes self-management
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Male, Poverty, Surveys and Questionnaires, Self Care, Software, Blood Glucose Self-Monitoring
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
