Does Self-Monitoring of Blood Glucose Levels Improve Dietary Compliance for Obese Patients with Type II Diabetes? RENA R. WING, Ph.D. LEONARD H. EPSTEIN, Ph.D. MARY PATRICJA NOWALK, M.S.Hyg. NANCY SCOTT, B.A. RANDI KOESKE, Ph.D. SIGRID HAGG, M.D. Pittsburgh, Pennsylvania From the University of Pittsburgh School of Medi- cihe, Pittsburgh, Pennsylvania. This work was supported by Grant AM-29757-04 from the Na- tional Institute of Arthritis, Metabolism, and Di- gestive Disease. Requests for reprints should be addressed to Dr. Rena R. Wing, Western Psychi- atric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, Pennsylvania 15213. Manuscript sub- mitted April 8, 1985, and accepted October 9, 1985. Self-monitoring of blood gtucose levels is currently. being recommend- ed for obese patients with type II diabetes to improve weight loss and glycemic control. To determine whether self-monitoring of blood glu- cose levels improves dietary compliance in these patients, 5d obese patients* with type II diabetes were randomly assigned either to a standard behavioral weight control program or to a weight control program that Included, self-monitoring of blood glucose levels and focused on the weight-blood glucose relationship. Both groups lost significant amounts of weight and maintained their losses for at least one year; reductions in medioation could be made for 70 percent of patients. These data suggest that the behavioral weight control used in this study may be of benefit to patients with type II diabetes. However, there was no evidence that the addition of self-monitoring of blood glucose levels to the treatment program irhproved the outcome in terms of weight loss, reduction in medication, dietary compliance, or mood state. Type II (non-insulin-dependent) diabetes is a major health problem in the United States, affecting more than six million persons and having a total economic impact of approximately $10 billion per year,[ I]. For the 60 to 90 percent of patients with type II diabetes who are obese, weight loss is the cornerstone of therapy. Weight loss reduces hyperglycemia &d insulin resistance and may lead to increased insulin secretion [2-41. Hypertension and hyperlipidemia, which are frequently associated with diabetes, may also improve with weight loss [5,6]. Although the benefits of weight reduction are well documented, the problem of getting patients to lose weight and maintain their losses remains.. In the University Group Diabetes Program, for example, patients assigned to the placebo-plus-diet group had only a 2.4 percent reduction in percent overweight at six months (weight loss of 1.9 kg), decreasing to a 1.6 percent reduction (less than 1 kg) at four years (71. Similarly poor weight losses-and, consequently, little or no improvement in blood glucose levels-have been obtained in other long-term controlled inves- tigations [8,9]. One technique currently advocated for improving dietary compliance in diabetic patients is self-monitoring of blood-glucose levels, By monitor- ing their blood glucose levels, patients can obtain immediate and accu- rate feedback on the effect of their eating and exercise patterns on blood glucose control. This feedback might serve to reinforce efforts at long- term habit change. Although self-monitoring of blood glucose levels has become popular in the management of type I diabetes and diabetes 030 November 1986 The Americln Journal of Medicine Volume 81