ROSSO-in-Praxi Follow-Up: Long-Term Effects of Self-Monitoring of Blood Glucose on Weight, Hemoglobin A1c, and Quality of Life in Patients with Type 2 Diabetes Mellitus

BACKGROUND: Self-monitoring of blood glucose (SMBG) is a simple tool to monitor the effects of lifestyle change on blood glucose. Recently, the ROSSO-in-praxi Study demonstrated that addition of SMBG to a 12-week lifestyle intervention was associated with significant improvements in glucometabolic control and quality of life in insulin-naive patients with type 2 diabetes mellitus (T2DM). So far it is unknown if this short-term intervention also has long-term effects. Therefore, participants were followed up for a mean period of 2 years. METHODS: Participants (n=327) were asked by mail for current weight, hemoglobin A1c (HbA1c), performance of SMBG, and quality of life (SF36 and CES-D questionnaires). Participants who did not reply were contacted by phone. RESULTS: Two hundred twenty-eight participants (70%) completed the follow-up. During the 12-week lifestyle intervention they had significantly reduced weight (2.2 kg) and HbA1c (0.3%; P<0.001 each). After 2 years they achieved a further reduction of weight (0.2 kg; P<0.001), whereas HbA1c increased again, remaining 0.1% lower than baseline. The numbers of depressed participants remained stable during follow-up, whereas physical and mental health-related quality of life remained better compared with baseline. During follow-up 20% of participants continued SMBG daily, 35% several times a week, and 33% irregularly. It is interesting that participants with daily SMBG demonstrated an HbA1c decrease of 0.3% at time of follow-up, whereas in those who stopped SMBG HbA1c increased by 0.1% (P=0.05). CONCLUSIONS: Integration of a short-term, motivational, and low-cost intervention into basic therapy of T2DM has had beneficial long-term effects on weight and quality of life and, if SMBG was continued daily, also on HbA1c.