Perceived value of self-monitoring blood glucose by primary care physicians and endocrinologists.

The value of self-monitoring blood glucose (SMBG) in patients with non-insulin-treated type 2 diabetes (NITT2DM) has been debated; however, the practice remains common. Patient perception of SMBG has been documented in several qualitative studies. However, the literature is lacking on the perceived value of SMBG by providers. This study used a structured questionnaire to evaluate and compare the perceived value, recommended frequency, and utility of SMBG in patients with NITT2DM by primary care providers (PCPs) and endocrinologists. A total of 70 PCPs and 14 endocrinologists completed the questionnaire. The results suggest that PCPs and endocrinologists find the practice of SMBG valuable in NITT2DM and believe it promotes behavioral changes in their patients. However, endocrinologists tend to recommend more frequent SMBG and find SMBG values more useful in making medication decisions. Conversely, PCPs tend to find the hemoglobin A1c more valuable than SMBG in making medication adjustments.

Prescribing patterns and outcomes among patients treated for gestational diabetes mellitus.

Insulin is recommended as first-line pharmacologic therapy for gestational diabetes (GDM); however, glyburide and metformin are often used. This study aimed to identify the most commonly prescribed agents for treating GDM, along with the maternal and fetal outcomes associated with their use. Electronic medical records were used to identify the medications prescribed for GDM at a large health system. Data were collected comparing medication failure rate, maternal weight gain, and incidence of fetal macrosomia, neonatal hypoglycemia, and premature delivery between the agents used. Of the 368 patients who met the inclusion criteria, 76.9% were initiated on glyburide, 13.6% were initiated on metformin, 8.2% were initiated on insulin, and 1.4% were initiated on a combination of glyburide and metformin. Glyburide was associated with less medication failure compared to insulin and metformin. There was no significant difference in maternal weight gain, fetal macrosomia, or neonatal hypoglycemia between the three classes of medications. However, recipients of basal and bolus insulin had a higher rate of preterm delivery compared to recipients of glyburide and metformin. Our findings suggest that glyburide and metformin are frequently prescribed over insulin as the initial treatment for GDM and appear to be safe and effective alternatives.