DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
• Kruger et al. (2003) determined that there was no significant difference in glycemic control among women
with gestational diabetes who transmitted SMBG data telephonically versus electronically. However, the
electronic transfer was shown to be more convenient and efficient for both patients and providers.
• An RCT by Kwon et al. (2004) studied the effects of Internet recording of SMBG with feedback and no
outpatient visits versus patients without Internet recordings but with monthly outpatient visits. There was a
small decrease in SMBG with the Internet recordings group and a small increase in SMBG with the non-
Internet recordings group.
• An RCT by Laffel et al. (2007) compared the effectiveness of using an integrated glucose meter and
electronic logbook and conventional meters and paper logbooks in a group of insulin treated patients. The
use of the integrated meter and electronic logbook resulted in small but significant improvement in HbA 1 c
up to one year
• In a meta-analysis by St. John et al. (2010), the results of five RCTs in patients with non–insulin-treated
type 2 diabetes were combined with two earlier RCTs which yielded a significant pooled SMBG-related
decrease in HbA 1 c of −0.22 (95% CI −0.34% to −0.11%).
EVIDENCE
Recommendation Sources LE QE SR
1 Instruction in interpretation and use of
SBGM data may improve glycemic
control.
Balk et al., 2007
Jansen et al., 2006
Sarol et al., 2005
McGeoch et al., 2007
I Fair C
2 Periodic HbA 1 c is sufficient to
ascertain diabetic control.
3 Consider SMBG in non-insulin
requiring type 2 diabetics undergoing
initiation or change of therapy,
illness, or hypoglycemia
unawareness and the SMBG data is
used to adjust treatment regimens
4 Utilizing SMBG data remotely is more
convenient for many patients without
adding an excess burden on providers
Coster et al., 2000
Faas et al., 1997
Harris et al., 2001
Meier et al., 2002
Oki et al., 1997
Piette & Glasgow, 2001
Wieland et al., 1997
Balk et al., 2007
Farmer et al., 2007
Jansen et al., 2006
McGeoch et al., 2007
O’Kane et al., 2008
Poolsup et al., 2008
Sarol et al., 2005
Simon et al., 2008
Towfigh et al., 2008
Welschen et al., 2005
Balas et al., 2004
Bergenstal et al., 2005
Farmer et al., 2005
Kruger et al., 2003
Kwon et al., 2004
Laffel et al., 2007
Montori et al., 2004
LE-Level of Evidence; QE = Quality of Evidence; SR = Strength of Recommendation (see Appendix A)
II Fair B
I
I
Fair
(small
benefit)
Fair
(small
benefit)
B
C
Module G: Glycemic Control Page 45