A participatory randomized controlled trial in knowledge translation (KT) to promote the adoption of self-monitoring of blood glucose for type 2 diabetes mellitus patients in an urban district of Thailand

Objective: To examine effectiveness of self-monitoring of blood glucose (SMBG) in glycemic control for poor control diabetes patients, and test whether the glycemic outcome for those with the 7-point SMBG was better than those with 5-point SMBG or usual care. Material and Method: Randomized-controlled trial (RCT) of patients with type 2 diabetes mellitus aged 30 years or older, HbA1c > 7. Patients were randomly allocated to one of three groups; 7-point SMBG, 5-point SBMG and control group. Differences in HbA1c at 6 months and baseline were compared among groups. Results: A total of 191 patients with poor control of diabetes were included. Compared with baseline, at 6 months, average change in HbA1c among control, 7-point, and 5-point SMBG were -0.38, -0.87, and -0.99 (p = 0.04), respectively. The corresponding percentages of patients with reduced HbA1c were 57.1%, 77.6% and 75.5%, respectively (p = 0.03). Using different cut-off values for HbA1c (<7 and <7.5) resulted in different percentage distribution of T2DM patients among the 3 groups, yet the differences were not statistically significant. Reductions in body weight were observed in both SMBG groups but not in the control group. Conclusion: Using RCT on participatory basis, SMBG with individual dietary counseling was effective in short term. Further engagement with the provider team, the patients/care takers and the health care financing agency to integrate SMBG in the care protocol for poor control diabetes should be considered.