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Biomedical subjects

William C Duckworth

Publications and source records attributed to William C Duckworth.

At least 19 recordsLinked to original sources
PubMed2006

Racial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study.

BACKGROUND: Racial/ethnic disparities in cardiovascular disease complications have been observed in diabetic patients. We examined the association between race/ethnicity and cardiovascular disease risk factor control in a large cohort of insulin-treated veterans with type 2 diabetes. METHODS: We conducted a cross-sectional observational study at 3 Veterans Affairs Medical Centers in the American Southwest. Using electronic pharmacy databases, we randomly selected 338 veterans with insulin-treated type 2 diabetes. We collected medical record and patient survey data on diabetes control and management, cardiovascular disease risk factors, comorbidity, demographics, socioeconomic factors, psychological status, and health behaviors. We used analysis of variance and multivariate linear regression to determine the effect of race/ethnicity on glycemic control, insulin treatment intensity, lipid levels, and blood pressure control. RESULTS: The study cohort was comprised of 72 (21.3%) Hispanic subjects (H), 35 (10.4%) African Americans (AA), and 226 (67%) non-Hispanic whites (NHW). The mean (SD) hemoglobin A1c differed significantly by race/ethnicity: NHW 7.86 (1.4)%, H 8.16 (1.6)%, AA 8.84 (2.9)%, p = 0.05. The multivariate-adjusted A1c was significantly higher for AA (+0.93%, p = 0.002) compared to NHW. Insulin doses (unit/day) also differed significantly: NHW 70.6 (48.8), H 58.4 (32.6), and AA 53.1 (36.2), p < 0.01. Multivariate-adjusted insulin doses were significantly lower for AA (-17.8 units/day, p = 0.01) and H (-10.5 units/day, p = 0.04) compared to NHW. Decrements in insulin doses were even greater among minority patients with poorly controlled diabetes (A1c > or = 8%). The disparities in glycemic control and insulin treatment intensity could not be explained by differences in age, body mass index, oral hypoglycemic medications, socioeconomic barriers, attitudes about diabetes care, diabetes knowledge, depression, cognitive dysfunction, or social support. We found no significant racial/ethnic differences in lipid or blood pressure control. CONCLUSION: In our cohort, insulin-treated minority veterans, particularly AA, had poorer glycemic control and received lower doses of insulin than NHW. However, we found no differences for control of other cardiovascular disease risk factors. The diabetes treatment disparity could be due to provider behaviors and/or patient behaviors or preferences. Further research with larger sample sizes and more geographically diverse populations are needed to confirm our findings.

Black or African American↗
PubMed2006

Baseline achievement of lipid goals and usage of lipid medications in patients with diabetes mellitus (from the Veterans Affairs Diabetes Trial).

The American Diabetes Association has established lipid goals for patients with diabetes. Although diabetic populations historically have poor low-density lipoprotein (LDL) cholesterol goal adherence, little is known about adherence to triglyceride and high-density lipoprotein (HDL) cholesterol goals. To determine the degree of lipid goal attainment among patients with diabetes, and to characterize the patterns of lipid medication use, we evaluated the baseline data from 1,742 enrollees of the national Veterans Affairs Diabetes Trial. Using current American Diabetes Association lipid guidelines, we calculated the proportion of participants achieving a LDL cholesterol level <100 mg/dl, triglyceride level <150 mg/dl, and HDL cholesterol level >40 mg/dl in men (>50 mg/dl in women). We also performed a descriptive analysis of the use of lipid medications in this population. The baseline LDL cholesterol level was 111 +/- 63 mg/dl, triglyceride level was 213 +/- 277 mg/dl, and HDL cholesterol was 36 +/- 10 mg/dl. At enrollment, 44% of veterans met the LDL cholesterol goal, 58% met the triglyceride goal, and 16% met the HDL cholesterol goal, but only 6% met all 3 goals. Of the 1,742 enrollees, 2/3 were receiving lipid therapy, with statins (58%) the most commonly used drug. Combination lipid therapy was used by 11% of enrollees. Although the enrollees of the Veterans Affairs Diabetes Trial demonstrated better adherence to the American Diabetes Association's LDL cholesterol goal than other diabetic populations recently studied, more aggressive and directed lipid medication use is needed to treat the overall lipid profile better.

Cholesterol, HDL↗
PubMed2005

Reliability and validity of the DCP among hispanic veterans.

The Diabetes Care Profile (DCP) was designed to measure psychosocial factors related to diabetes and its treatment. This study sought to determine the reliability and validity of the DCP in Hispanic veterans with Type 2 diabetes. Hispanic (n=81) and non-Hispanic White (n=238) patients were recruited at three southwestern VA hospitals. Scale reliabilities calculated by Cronbach's coefficient alpha revealed reliabilities ranging from .54 to .97 in Hispanics and .63 to .95 in non-Hispanic Whites. Only one scale, Monitoring Barriers, differed significantly between the two patient groups. Mean values on the DCP scales were consistent within and across ethnicities lending support for construct validity of the DCP in Hispanics. Convergent validity was also supported for DCP scales within the Hispanic patients as evidenced by correlations in expected directions with external measures.

Aged↗
PubMed2004

A probabilistic model for predicting hypoglycemia in type 2 diabetes mellitus: The Diabetes Outcomes in Veterans Study (DOVES).

BACKGROUND: To develop and validate a method for estimating hypoglycemia risk in stable, insulin-treated subjects with type 2 diabetes mellitus. METHODS: Subjects (n = 195) monitored their blood glucose levels 4 times daily for 8 weeks. An 8-week mean blood glucose value (GLUMEAN) with standard deviation (GLUSD) was derived for each patient. Subjects were then randomly allocated to a derivation or validation set. For the derivation set, we developed a logistic function based on GLUMEAN and GLUSD to describe the 8-week risk of hypoglycemia (blood glucose < or =60 mg/dL [3.3 mmol/L]). This function was used to assign a predicted probability of hypoglycemia to each subject in the validation set. Subjects were assigned to risk quartiles and followed up for up to 52 weeks. RESULTS: We evaluated 195 subjects, 95% of whom were men and 69% of whom were non-Hispanic white. For 72 derivation subjects, GLUMEAN and GLUSD were highly influential determinants of hypoglycemia during intensified monitoring. The 123 validation subjects were followed up for 39.7 +/- 7.1 weeks (mean +/- SD). The occurrence of long-term hypoglycemia differed significantly across risk quartiles (19.4%, 36.7%, 61.3%, and 77.4%, respectively; P<.001). Receiver operating characteristic curve analysis showed that the area for the probability function (0.746 +/- 0.046) was significantly higher than the area for hemoglobin A1c (0.549 +/- 0.052) because their 95% confidence intervals did not overlap. The function also identified subjects who developed long-term hypoglycemia at a rate exceeding the median frequency. CONCLUSIONS: Self-monitoring of blood glucose is superior to hemoglobin A1c measurement in predicting long-term hypoglycemia in persons with type 2 diabetes. The risk of hypoglycemia associated with treatment intensification may be offset by strategies that reduce glucose variability.

Adult↗
PubMed2004

Biological activity of a fragment of insulin.

Insulin controls or alters glucose, protein, and fat metabolism as well as other cellular functions. Insulin binds to a specific receptor on the cell membrane initiating a protein phosphorylation cascade that controls glucose uptake and metabolism and long-term effects such as mitogenesis. This process also initiates insulin uptake and ultimate cellular metabolism in all insulin sensitive cells. The effects of insulin on other cellular metabolic properties have not been clearly related to this mechanism. Here we show that intracellular metabolism of insulin may be related to some aspects of insulin actions, specifically control of fat metabolism. A normal intracellular degradation product of insulin has been synthesized and tested for actions on fat turnover in cultured adipocytes. This 7-peptide, B-chain fragment (HLVEALY) inhibits both basal and stimulated lipolysis as measured by glycerol release, but does not inhibit FFA release because of a lack of effect on FFA reesterification in the adipocyte. HLVEALY also enhances insulin's effects on lipogenesis. This study shows that a fragment of insulin produced by the action of the insulin-degrading enzyme has both independent biological effects and interactions with insulin. This supports a biologically important effect of insulin metabolism and insulin degradation products on insulin action on non-glucose pathways.

3T3 Cells↗
PubMed2004

Hypoglycemia in type 2 diabetes: a critical review.

Hypoglycemia is the most important barrier to tight glycemic control. Although severe hypoglycemia is uncommon, milder events can occur so often that they represent a deterrent to intensifying treatment. High-risk patient behaviors are the most important cause for episodes for which a cause can be identified. Because symptoms are an unreliable way of establishing the diagnosis, SMBG should be considered for the patients at highest risk, particularly as they approach their glycemic targets. SMBG is superior to HbA1c in forecasting the hypoglycemia rate because it provides information about glucose variability--an independent risk factor. Patient education and medication changes are potential ways of reducing the hypoglycemia rate. However, it remains to be proven that patient education is beneficial in this regard.

Circadian Rhythm↗
PubMed2004

Factors affecting hypoglycemia awareness in insulin-treated type 2 diabetes: The Diabetes Outcomes in Veterans Study (DOVES).

OBJECTIVE: To identify clinical factors that affect hypoglycemia perception in type 2 diabetes. METHODS: Prospective observational study of 344 insulin-treated subjects randomly selected from pharmacy records at three large medical centers. At entry, subjects underwent an extensive psychological evaluation and then monitored their blood glucoses in their usual fashion for up to 52 weeks using a glucose meter capable of storing 1000 readings. For blood glucoses <or=3.33 mmol/l (60 mg/dl), subjects recorded the severity of symptoms in a log book. Symptoms were scored '0' if they were asymptomatic, '1' for symptoms that were mild-to-moderate, and '2' if the subject had a diminished level of consciousness or required the assistance of others. A mean blood glucose and mean symptom score were calculated for all hypoglycemic episodes detected by each patient. RESULTS: One hundred seventy-six subjects (51.2%) had a median of 4.5 hypoglycemic events during 42.5+/-8.0 weeks of follow-up. The mean hypoglycemic blood glucoses and mean symptom scores were modestly correlated (r=0.153; P=0.043). After adjusting for blood glucose, symptom scores were lower in the elderly and higher in subjects with higher diabetes knowledge scores, microvascular complications, and higher entry hemoglobin A1c. Multiple linear regression showed that the latter three factors were independently predictive of higher symptoms. CONCLUSIONS: Conventional clinical data may be useful in identifying patients with poor hypoglycemia perception. Patients with better long- and short-term glycemic control are at higher risk and may benefit from instruction on all aspects of hypoglycemia.

Aged↗
PubMed2004

Food frequency questionnaire results correlate with metabolic control in insulin-treated veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study.

OBJECTIVE: To validate food frequency analysis as a predictor of metabolic status in persons with type 2 diabetes and to identify psychosocial factors affecting dietary adherence. METHODS: Three hundred forty-seven subjects with stable, insulin-treated type 2 diabetes completed a food frequency questionnaire and six instruments measuring different psychosocial attributes. Eight metabolic parameters were used as principal endpoints. Data from the food frequency questionnaires were used to estimate daily energy intake and determine each subject's adherence to seven dietary standards derived from the 2003 Dietary Recommendations of the American Diabetes Association. We excluded 105 subjects reporting daily energy intake <1,000 kcal because these results were considered unreliable. Subjects were then categorized into three groups depending on their adherence rates to American Diabetes Association dietary standards. RESULTS: Subjects with the lowest dietary adherence had the poorest metabolic control. Adherence to dietary standards was particularly poor among subjects with metabolic syndrome (2.1%) and/or obesity (4.1%). The most important determinants of following recommended dietary practices were positive attitudes, fewer social barriers, and a conviction that diet could control diabetes. CONCLUSIONS: For subjects with type 2 diabetes reporting a dietary intake of >1,000 kcal/day, food frequency questionnaire data could identify those with poor metabolic control. Nutrition interventions to improve metabolic control should focus on reducing fat intake and emphasizing the importance of diet. Multidisciplinary efforts should be directed at overcoming social barriers to recommended dietary practices and to treating depression.

Aged↗
PubMed2004

Reduced action of insulin glargine on protein and lipid metabolism: possible relationship to cellular hormone metabolism.

Insulin analogues are used in the treatment of diabetes to mimic physiological insulin secretion. Glargine is used to provide basal insulin levels. Previous work has shown no differences in glucose uptake when glargine was compared to native insulin. The action of insulin on protein and lipid metabolism is studied infrequently, but these important actions should be considered with insulin analogues. In HepG2 cells, protein degradation was inhibited significantly less by glargine (15% over 3 hours) than by insulin (approximately 20% over 3 hours) (P < .05). Lipid metabolism was investigated in 3T3-L1 cells. In these cells glucose oxidation to CO2 was effected equally, but glargine was less potent than insulin at inhibiting epinephrine-stimulated lipolysis (EC50 = 1.4 v 0.35 nmol/L, P < .001) and at stimulating lipogenesis (EC50 = 1.27 v 8.06 nmol/L, P < .01). Since the action of insulin on protein and lipid metabolism has been suggested to be due to the metabolism of the hormone, we compared the cellular handling of 125I[A14]-glargine to 125I[A14]-insulin in HepG2 cells. While binding of glargine to the insulin receptor was identical to insulin, degradation of glargine was reduced compared to insulin (16.3% +/- 0.3% v 21.6% +/- 0.4% degraded/h, P < .01). Less degraded glargine than insulin was released from cells previously loaded with radiolabeled material (50.1% +/- 2.4% v 58.3% +/- 1.4%/2 h, P < .02). The amount of intact glargine released was concomitantly increased compared to insulin (44.8% +/- 2.6% v 35.8% +/- 1.4%/2 h, P < .02). These data provide further evidence for a relationship between insulin metabolism and insulin action on protein and lipid metabolism; however, the clinical relevance of these differences is hard to realize, since for the most part glargine, used as a basal insulin, is administered in addition to other shorter-acting insulin or analogues, and their effects will mask or reduce glargine effects on lipolysis and protein degradation. However, these studies do show that properties of insulin other than glucose metabolism and mitogenesis must be considered when studying insulin analogues.

Cell Membrane↗
PubMed2004

Contributions of weekly mean blood glucose values to hemoglobin A1c in insulin-treated type 2 diabetes: the Diabetes Outcomes in Veterans Study (DOVES).

BACKGROUND: Daily self-monitored blood glucose testing is recommended for patients with insulin-treated type 2 diabetes. However, most patients do not test frequently enough for optimal glycemic control. Less frequent testing may be sufficient for assessing glycemic control among stable patients as well as improving patient compliance. The study objective was to evaluate the weekly contribution of glucose readings to hemoglobin (Hb)A1c during an 8-week period of intensified self-monitored blood glucose testing. METHODS: The authors randomly selected stable, insulin-treated subjects with type 2 diabetes. Subjects monitored their blood glucose four times daily for 8 weeks; the authors then downloaded glucose meters and measured an HbA1c. Mean blood glucose values were calculated for each of the 8 weeks. Multiple linear regression analyses examined the contribution of these mean values to the HbA1c. RESULTS: A total of 182 subjects completed the monitoring protocol; mean HbA1c was 7.63 +/- 1.42%, mean glucose was 9.78 +/- 2.27 mmol/L, the regression correlation was 0.77, P < 0.001. A fitted multiple linear model using all 8 weekly mean blood glucose values showed large variation in their independent contributions to the HbA1c. Mean blood glucose values from consecutive weeks were highly correlated and did not provide independent information about glycemic control. Stepwise regression showed that the mean blood glucose values from weeks 4, 6, and 8 significantly and equally influenced HbA1c. CONCLUSIONS: Glycemic control can be efficiently assessed by reviewing at least 5 weeks' worth of monitoring results, focusing on alternate weeks and giving less weight to more remote readings.

Aged↗
PubMed2004

Control of proteolysis: hormones, nutrients, and the changing role of the proteasome.

PURPOSE OF REVIEW: The maintenance of protein balance is essential for the proper functioning of a cell. Protein degradation must be controlled to account for the availability of nutrients and hormone signals from the body as a whole. The proteasome is the major cytosolic protein degrading machinery, and is responsible for a considerable proportion of cellular protein degradation. It is thus a prime site for the integration of these various signals. We will examine some recent data regarding the mechanisms for control of the peptidolytic activities of the proteasome, and possible implications for signal transduction and integration. RECENT FINDINGS: Nutrients, such as amino acids and fatty acids, have been shown to have effects on proteasome-mediated protein degradation. The ubiquitinylating process is important for the control of protein degradation by the 26S proteasome. Amino acids and hormones control the expression of the necessary components, and can control protein degradation on a relatively longer-term basis. The 20S proteasome has been shown to be capable of degrading proteins without activating subunits. Furthermore, the 20S proteasome is allosterically affected by a number of smaller peptides, suggesting a more immediate mechanism for control. Amino acids and fatty acids have been shown to exert such control in vitro. SUMMARY: As more is learned about the functioning of the proteasome, the greater appreciation we have of its vital role in the control of cellular metabolism. Recent evidence shows that the proteasome is central to the integration of various nutrient and hormonal signals that the cell receives that may impact on protein metabolism.

Amino Acids↗
PubMed2004

Sources of glucose variability in insulin-treated type 2 diabetes: the Diabetes Outcomes in Veterans Study (DOVES).

OBJECTIVE: Glucose variability can be a significant barrier to glycaemic control for diabetic patients on insulin. The study identified clinical and behavioural factors associated with glucose variability in type 2 diabetes. DESIGN: Observational study. SUBJECTS: Randomly selected veterans with stable, insulin-treated type 2 diabetes. MEASUREMENTS: Baseline data included demographics, clinical characteristics, diet, activity and haemoglobin A1c. Subjects self-monitored blood glucose before all meals and at bedtime for 8 weeks. Monitoring data were used to derive an overall glucose mean and glucose coefficient of variation (100*SD/mean) for each subject. Univariate and multivariate analyses were used to evaluate the relationship between glucose coefficient of variation and clinical factors. RESULTS: Two-hundred and four subjects completed the protocol. The 8-week mean (+/- SD) glucose was 9.9 +/- 2.2 mmol/l, and the average overall coefficient of variation was 35.6 +/- 7.7%. Univariate analysis showed a higher variation in older subjects and in those with longer duration of insulin treatment, greater consumption of sugars and greater confidence in their self-care abilities. Variation was lower in subjects who were obese, more compliant with medications and receiving larger insulin doses. Multivariate analysis showed that treatment duration, sugar consumption, medication compliance and insulin dose were independently associated with glucose variation. Medication compliance was more influential for fasting variation, while body mass index was more influential for before lunch variation. CONCLUSIONS: Numerous behavioural, clinical and treatment factors were independently associated with glucose variability. Reducing sugar consumption and improving medication compliance might offset the greater glucose fluctuation observed in lean patients with longstanding diabetes.

Age Factors↗
PubMed2004

Insulin-degrading activity in wound fluid.

Patients with diabetes are at great risk of developing lower extremity ulcers. The management of diabetic foot ulcers typically includes early recognition and appropriate clinical care. Recent advances in wound treatment include topical growth factor therapy, which has been successful in diabetic wounds. Growth factors are decreased in wound fluid; this may be due to decreased supply, increased binding, or increased degradation of the naturally occurring growth factors. This study investigates the activity of the insulin-degrading enzyme in wound fluid. Wound fluid was obtained from patients with (n = 17) and without (n = 4) diabetes. Insulin degradation was assayed by incubating [(125)I]insulin with wound fluid and precipitation in trichloroacetic acid. Fluid from nondiabetics degraded 2.22 +/- 0.73%, whereas diabetic fluid degraded significantly more (6.13 +/- 1.48%; P < 0.05). In patients with diabetes, the degradation of insulin by wound fluid correlated with glucose control (hemoglobin A(1c); r(2) = 0.5353; P < 0.001), and patients with worse outcomes (i.e. amputation) had higher wound fluid insulin degradation. The biochemical characteristics of insulin degradation in the wound fluid were consistent with the characteristics of insulin-degrading enzyme. These data suggest that glucose control is a critical factor in wound healing, but a reduction in the insulin-degrading activity in the wound fluid is also a potential therapeutic target.

Amputation, Surgical↗
PubMed2003

Inhibition of proteasome activity by selected amino acids.

Cellular protein homeostasis is a balance between synthesis and degradation. Protein degradation is regulated by hormones (eg, insulin) and nutrients (eg, amino acids). Certain amino acids are capable of decreasing cellular protein degradation, with evidence that this is mediated through altered lysosomal function. However, proteasomes, the major cytosolic protein degrading machinery, are being shown to play a central role in the control of protein turnover in the cell. In this study we show that the amino acids, isoleucine, leucine, tyrosine, phenylalanine, tryptophan, lysine, and arginine are capable of inhibiting the chymotrypsin-like activity of the proteasome in a dose-dependent manner. Leucine, tyrosine, and phenylalanine have a substantial effect at normal serum concentrations. The effect was greater in a proteasome preparation derived from muscle compared to a similar preparation from liver. On the assumption that amino acid-induced alterations in cellular protein degradation reflect the inhibitory changes in proteasomal activity shown here, we may conclude that amino acid control of cellular protein degradation is mediated, at least in part, through proteasomes.

Amino Acids↗
PubMed2003

Beneficial effects of a glyburide/metformin combination preparation in type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes mellitus is characterized by both insulin deficiency and insulin resistance. Effective treatment often requires therapy directed at both abnormalities. Patients on monotherapy might benefit from a combination agent such as glyburide/metformin, which increases insulin secretion and reduces insulin resistance. METHODS: All patients taking a glyburide/metformin preparation at the Carl T. Hayden VAMC were identified from pharmacy records. Patients with documented hemoglobin A values within 31 weeks prior and between 3 and 33 weeks after initiation of therapy (92 subjects) were examined. RESULTS: Glyburide/metformin combination therapy reduced hemoglobin A levels from 0.087 to 0.083 (P < 0.06). Significant reductions were seen in those patients with initial levels higher than 0.08 (0.094 to 0.087; P < 0.01). No significant reductions were seen in those patients with initial levels lower than 0.08. CONCLUSIONS: In patients on monotherapy or on dual oral therapy with inadequate control, changing to a glyburide/metformin combination preparation may improve glucose control.

Blood Glucose↗
PubMed2003

An insulin-degrading enzyme inhibitor decreases amylin degradation, increases amylin-induced cytotoxicity, and increases amyloid formation in insulinoma cell cultures.

Amylin (islet amyloid polypeptide) is the chief component of the islet amyloid found in type 2 diabetes, and amylin fibril precursors may be cytotoxic to pancreatic beta-cells. Little is known about the prevention of amylin aggregation. We investigated the role of insulin-degrading enzyme (IDE) in amylin degradation, amyloid deposition, and cytotoxicity in RIN-m5F insulinoma cells. Human (125)I-labeled amylin degradation was inhibited by 46 and 65% with the addition of 100 nmol/l human amylin or insulin, respectively. (125)I-labeled insulin degradation was inhibited with 100 nmol/l human amylin, rat amylin, and insulin (by 50, 50, and 73%, respectively). The IDE inhibitor bacitracin inhibited amylin degradation by 78% and insulin degradation by 100%. Amyloid staining by Congo red fluorescence was detectable at 100 nmol/l amylin and was pronounced at 1,000 nmol/l amylin treatment for 48 h. Bacitracin treatment markedly increased staining at all amylin concentrations. Bacitracin with amylin caused a dramatic decrease in cell viability compared with amylin alone (68 and 25%, respectively, at 10 nmol/l amylin). In summary, RIN-m5F cells degraded both amylin and insulin through a common proteolytic pathway. IDE inhibition by bacitracin impaired amylin degradation, increased amyloid formation, and increased amylin-induced cytotoxicity, suggesting a role for IDE in amylin clearance and the prevention of amylin aggregation.

Amyloid↗
PubMed2003

Intensified blood glucose monitoring improves glycemic control in stable, insulin-treated veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study (DOVES).

OBJECTIVE: To examine the effect of intensified self-monitored blood glucose (SMBG) testing on glycemic control. RESEARCH DESIGN AND METHODS: Subjects with stable, insulin-treated type 2 diabetes performed SMBG using an electronic blood glucose meter before all meals and at bedtime for 8 weeks. Baseline data were collected on demographics, clinical characteristics, diet, and exercise. HbA(1c) was measured at baseline, at 4 weeks, and at 8 weeks. After the intensified monitoring period, subjects resumed their usual monitoring. HbA(1c) was then measured at 24, 37, and 52 weeks. Multivariate linear regression was used to determine the effect of monitoring on glycemic control. RESULTS: A total of 201 subjects completed the monitoring period. The baseline HbA(1c) (8.10 +/- 1.67%) decreased during the monitoring period by 0.30 +/- 0.68% (P < 0.001) at 4 weeks and by 0.36 +/- 0.88% (P < 0.001) at 8 weeks. Although entry HbA(1c) and compliance independently predicted the week 8 HbA(1c) (r = 0.862, P < 0.001), standardized regression analysis found that compliance with the SMBG protocol influenced the week 8 HbA(1c) more than age, sex, BMI, exercise level, carbohydrate consumption, or treatment intensity at baseline. However, SMBG benefited only subjects whose testing compliance exceeded 75% or with an entry HbA(1c) >8.0%. Decreases in HbA(1c) (-0.31 +/- 1.17%, P = 0.001) persisted in the 159 subjects followed for 52 weeks. CONCLUSIONS: Intensified blood glucose monitoring improved glycemic control in a large cohort of stable, insulin-treated veterans with type 2 diabetes. SMBG provided a strong stimulus for improved self-care resulting in clinically important and sustained reductions in HbA(1c).

Biomarkers↗