Use of an integrated strip-free blood glucose monitoring system increases frequency of self-monitoring and improves glycemic control: Results from the ExAct study

• Main Authors: Alberto Maran, MD, Diethelm Tschoepe, MD, Maurizio Di Mauro, MD, William A. Fisher, PhD, Kurt Loeffler, PhD, Iris Vesper, MS, Sandra Bloethner, PhD, Oliver Mast, MSc, Joerg Weissmann, MD, Ildikó Amann-Zalán, MD, Annette Moritz, PhD, Christopher G. Parkin, MS, Taylor Kohut, MSc, Iain Cranston, MD, FRCP
• Format: Article
• Language: English
• Published: Elsevier 2014-12-01
• Series: Journal of Clinical & Translational Endocrinology
• Subjects: Adherence; Self-monitoring of blood glucose; SMBG; Type 1 diabetes; Type 2 diabetes; Testing frequency; Insulin; Glycemic control; HbA1c; Integrated strip-free system
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214623714000325

Aims: We investigated the impact of using an integrated, strip-free system compared to the use of single-strip systems on testing frequency and glycemic control in individuals with insulin-treated diabetes. Methods: This multinational, comparative, cluster-randomized, observational study included 311 patients with type 1 and insulin-treated type 2 diabetes who were performing SMBG at suboptimal frequencies. Sites were cluster-randomized to “integrated strip-free” system (EXP group) or any “single-strip” system (CNL group). Testing frequency and HbA1c were measured at baseline, 12 weeks and 24 weeks. Results: At week 24, the EXP group showed an increase in SMBG frequency from baseline of 4.17 tests/week (95% CI 2.76, 5.58) compared with an increase of 0.53 tests/week (95% CI −0.73, 1.79) among CNL patients, resulting in a between-group difference of 3.63 tests/week (p < 0.0002). Mixed-effects models for repeated measurements (MMRM) controlling for baseline frequency of testing, country and clinical site confirmed a higher SMBG testing frequency in the EXP group compared to the CNL group, with a between-group difference of 2.70 tests/week (p < 0.01). Univariate analysis showed greater HbA1c reductions in the EXP group than CNL group: −0.44% (95% CI −0.59, −0.29) vs. −0.13% (95% CI −0.27, 0.01), respectively, p < 0.0002. MMRM analyses confirmed these HbA1c reductions. A greater percentage of EXP than CNL patients achieved HbA1c reductions of ≥0.5%: 45.1% vs. 29.1%, respectively, p < 0.01. Conclusions: The use of an integrated, strip-free SMBG system improved testing adherence and was associated with improvements in glycemic control.