Objective : To study the effetciveness of structured intensive testing versus routine testing protocols in self monitoring of blood glucose (SMBG)on glycemic control and quality of life in Type 2 diabetic asian indian patients on oral anti diabetic agents .In a resource limited country like India can intensive structured testing make an impact on diabetes control in a cost effective was the primary objective of the study.
Methods : 197 outpatients of type 2diabetes on oral ant diabetic medications were randomly allocated into two tetsing protocols .One group did structured intensive testing (SIT;n=99) where once in 3 months 7 points testing was done daily for 3 consecutive days and other group did routine testing (RT;n=98)at least twice a week 3 points .The primary end point was glycosylated hb (HbA1c) and secondary endpoints were quaility of life,treatment change,hypoglycemia ,blood pressure and body weight.The study was done for one year and variables measure every 3 months
Results : Glycosylated Hb were signficantly reduced by 0.91% in the SIT group due to more prompt modulation of both lifetsyle and medication change by the treatment team compared to the RT group.Also in the SIT group there was better quality of life ,lesser hypoglycemic episodes compared to the RT group.But surprisingly Blood pressure and body weight decreased more in the RT group due to possible better lifestyle focus and lesser therapy change.All cases were type 2 diabetes cases and on oral anti diabetic agents.In SIT group more cases were change from hypoglycemic agents (secretagoges) to non hypoglycemic agents(gliptins) compared to the RT group.
Discussion : India is a low SMBG freqency testing country and is out of pocket expense .In this scenario structured intensive testing protocol is far more impactful on glycemic control and qaulity of life than Routine testing,SIT allows even in low frequency testing situations to make diabetes management better and improves glycemic control,lowers hypoglycemia and better qaulityof life
Conclusion : This simple Structured testing protocol without daily comparred to routine testing testing shows thats its benefical for glycemic control in type 2 diabetes patinets on oral anti diabetic agents with a favourable impact on qaulity of life and lesser hypoglycemic epsiodes.
Shashank Joshi– Senior Endocrinologist, Lilavati and Bhatia Hospital, Mumbai, Maharashtra, India
Abhishek Bhatarachrya– RESEARCH ASSOCIATE, JOSHI CLINIC
Aditya Hingwala– RESEARCH ASSOCIATE, JOSHI CLINIC
Varsha Khatry– HEAD MEDICAL AND SCIENTIFIC AFFAIRS, ROCHE DIABETES CARE
Lilavati and Bhatia Hospital
Mumbai, Maharashtra, India
Prof Shashank R. Joshi MD, DM, FACP, FACE, FRCP
Endocrinologist, Lilavati & Bhatia Hospital
Consultant and Advisor, Apollo Sugar Clinics
President, Indian Academy of Diabetes, Past President, Endocrine Society of India
Past President, Research Society for Study of Diabetes in India(RSSDI)
Past President, All India Association for Advancement of Research in Obesity Past President, Association of Physicians of India, Emeritus Editor, JAPI
Indian Chapter Chair, AACE
He was honored by the Government of India, in 2014, by bestowing on him the Padma Shri, the fourth highest civilian award, for his services to the field of medicine. He is also a recipient of the International Clinician Award, received at the 21st American Association of Clinical Endocrinologists (AACE) Annual Scientific and Clinical Congress, Philadelphia. This is an annual award given to practicing endocrinologists, outside the US
RESEARCH ASSOCIATE AT JOSHI CLINIC
REASEARCH ASSOCIATE AT JOSHI CLINIC