The impact of structured blood glucose testing on attitudes toward self-management among poorly controlled, insulin-naive patients with type 2 diabetes

Diabetes Research and Clinical Practice, 05/25/2012

Fisher L et al. – Structured self–monitoring of blood glucose (SMBG) leads to significant increases in self–confidence and autonomous motivation associated with diabetes self–management. Changes in self–confidence are linked to changes in glycemic control and share a time–concordant relationship.


  • The Structured Testing Program (STeP) is a 12–month, two–arm, cluster–randomized trial that assessed the efficacy of structured SMBG in 483 insulin–naïve T2DM patients.
  • Measures included: Confidence in Diabetes Self–Care for Type 2 patients (CIDS–T2), Diabetes–related Autonomous Motivation (DRAM), self–management behaviors and HbA1c.


  • Intent–to–treat (ITT) and per–protocol (PP) analyses showed significant increases in CIDS–T2 scores over time (main effects p<0.0001).
  • PP analysis showed significant between–group differences (p<0.05), with adherent STG patients displaying greater CIDS–T2 improvement than ACG patients.
  • PP analyses showed main and between–group effects in DRAM with similar findings.
  • Changes in CIDS–T2 were related to HbA1c changes over time; no self–management variable mediated this relationship.
  • CIDS–T2 and HbA1c displayed a significant time–concordant relationship.

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