Use of an integrated strip-free blood glucose monitoring system increases frequency of self-monitoring and improves glycemic control: Results from the ExAct study

Aims: We investigated the impact of using an integrated, strip-free system compared to the use of single- strip systems on testing frequency and glycemic control in individuals with insulin-treated diabetes. Methods: This multinational, comparative, cluster-randomized, observational study included 311 patients with type 1 and insulin-treated type 2 diabetes who were performing SMBG at suboptimal frequencies. Sites were cluster-randomized to “integrated strip-free” system (EXP group) or any “single-strip” system (CNL group). Testing frequency and HbA1c were measured at baseline, 12 weeks and 24 weeks. Results: At week 24, the EXP group showed an increase in SMBG frequency from baseline of 4.17 tests/ week (95% CI 2.76, 5.58) compared with an increase of 0.53 tests/week (95% CI 0.73, 1.79) among CNL patients, resulting in a between-group difference of 3.63 tests/week (p < 0.0002). Mixed-effects models for repeated measurements (MMRM) controlling for baseline frequency of testing, country and clinical site confirmed a higher SMBG testing frequency in the EXP group compared to the CNL group, with a between- group difference of 2.70 tests/week (p < 0.01). Univariate analysis showed greater HbA1c reductions in the EXP group than CNL group: 0.44% (95% CI 0.59, 0.29) vs. 0.13% (95% CI 0.27, 0.01), respectively, p < 0.0002. MMRM analyses confirmed these HbA1c reductions. A greater percentage of EXP than CNL patients achieved HbA1c reductions of !0.5%: 45.1% vs. 29.1%, respectively, p < 0.01. Conclusions: The use of an integrated, strip-free SMBG system improved testing adherence and was associated with improvements in glycemic control.