ArticlesContributions of Weekly Mean Blood Glucose Values to Hemoglobin A1c in Insulin-Treated Type 2 Diabetes: The Diabetes Outcomes in Veterans Study (DOVES)
Section snippets
Methods
The Diabetes Outcomes in Veterans Study (DOVES) was a prospective, observational study of risk factor control in stable, insulin-treated veterans with type 2 diabetes. The primary objective of DOVES was to identify correctable problems with implementing methodologies shown to improve outcomes in type 2 patients. The study methodology has been described elsewhere.13 Briefly, potential subjects were identified from computer pharmacy records at the New Mexico VA Health Care System, the Carl T.
Results
Two hundred forty-seven subjects were invited to participate in the study and 218 consented to be enrolled (88%). We subsequently excluded 36 subjects, including 8 who failed to follow the protocol after initially consenting, 9 who did not obtain the follow-up HbA1c, and 19 who missed more than 3 consecutive days of readings. The remaining 182 subjects (74% of those eligible) form the basis for this report. The mean age (± SD) of this group was 65.3 ± 9.6 years; 96% were men, and 29% were
Discussion
The American Diabetes Association recommends following patients with diabetes at intervals of no more than 3 months8 and having insulin-treated patients frequently perform SMBG.23 A provider complying with these standards may face a conundrum when assessing insulin treatment. If the readings in the preceding 3 months contribute equally to a high HbA1c, then they should all be reviewed to identify recurring patterns of hyperglycemia. However, if the patient has been monitoring three to four times
Conclusion
We found significant variation in the contribution of weekly mean blood glucose values to HbA1c measured at the end of 8 weeks. In stable, insulin-treated veterans, no independent information about overall glycemic control is obtained from the second of 2 consecutive weeks or from readings more than 5 weeks old. These findings may offer providers some guidance in assessing SMBG data and improve patient testing compliance. Our findings, though, relate to glycemic control and do not imply that
Acknowledgments
We thank the patients who participated in this study and our study coordinators: Karen D. Adam, RN, Patricia A. Solvas, RN, and Syed U. Bokhari, MD.
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Supported by a grant (VCR 99–007) from the Health Services Research & Development Service and the Veterans Integrated Service Network 18, Department of Veterans Affairs.