Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry∗
Abstract
Purpose We sought to evaluate the effectiveness of self-monitoring blood glucose levels to improve glycemic control.Subjects and methods A cohort design was used to assess the relation between self-monitoring frequency (1996 average daily glucometer strip utilization) and the first glycosylated hemoglobin (HbA1c) level measured in 1997. The study sample included 24,312 adult patients with diabetes who were members of a large, group model, managed care organization. We estimated the difference between HbA1c levels in patients who self-monitored at frequencies recommended by the American Diabetes Association compared with those who monitored less frequently or not at all. Models were adjusted for age, sex, race, education, occupation, income, duration of diabetes, medication refill adherence, clinic appointment "no show" rate, annual eye exam attendance, use of nonpharmacological (diet and exercise) diabetes therapy, smoking, alcohol consumption, hospitalization and emergency room visits, and the number of daily insulin injections.Results Self-monitoring among patients with type 1 diabetes (> or = 3 times daily) and pharmacologically treated type 2 diabetes (at least daily) was associated with lower HbA1c levels (1.0 percentage points lower in type 1 diabetes and 0.6 points lower in type 2 diabetes) than was less frequent monitoring (P < 0.0001). Although there are no specific recommendations for patients with nonpharmacologically treated type 2 diabetes, those who practiced self-monitoring (at any frequency) had a 0.4 point lower HbA1c level than those not practicing at all (P < 0.0001).Conclusion More frequent self-monitoring of blood glucose levels was associated with clinically and statistically better glycemic control regardless of diabetes type or therapy. These findings support the clinical recommendations suggested by the American Diabetes Association.
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Most evidence indicates that SMBG contributes to good glycemic control among type 1 and type 2 diabetic patients.
“Although most evidence indicates that SMBG contributes to good glycemic control among type 1 (4,5) and type 2 diabetic (6,7) patients, it remains uncertain whether SMBG use is efficacious in insulin-naïve type 2 diabetic patients.”
From Structured Self-Monitoring of Blood Glucose Significantly Reduces A1C Levels in Poorly Controlled, Noninsulin-Treated Type 2 Diabetes (2011) · cites this paper as [7]
Self-monitoring leads to improved diet and physical activity along with greater medication adherence.
“Self-monitoring is a critical health management task that requires careful attention to health stimuli and leads to improved diet and physical activity [59] along with greater medication adherence [60].”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [60]
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- Authors
- Karter, A. J., Ackerson, L. M., Darbinian, J. A., D’Agostino, R. B., Ferrara, A., Liu, J., & Selby, J. V.
- Affiliations
- Kaiser Permanente (US)
- Wake Forest University Health Sciences (US)
- Corresponding author
- Karter, Andrew J
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2001-07
- Volume
- 111
- Issue
- 1
- Pages
- 1-9
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W1992108504
- Cited by
- 595
- References
- 46
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 15 · 2023: 13 · 2022: 8 · 2021: 9 · 2020: 12 · 2019: 22 · 2018: 30 · 2017: 32 · 2016: 31 · 2015: 36 · 2014: 27 · 2013: 33 · 2012: 32
- FWCI
- 12.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Diabetes Association
- Kaiser Permanente
- National Cancer Institute (R01CA079934, CA79934)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- self-monitoring of blood glucose, glycemic control, HbA1c, type 1 diabetes, type 2 diabetes, diabetes management, managed care, Kaiser Permanente
- MeSH terms
- Adult, Aged, California, Diabetes Mellitus, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Male, Middle Aged, Patient Compliance, Registries, Time Factors, United States, Blood Glucose Self-Monitoring, Practice Guidelines as Topic
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 ›
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