Cross-sectional studyindependent cross-checkabstract checked★ key study I-DIAB-110 in-depth review
Checking blood sugar more often goes with better control in type 1 diabetes
Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A1c levels in T1D exchange clinic registry participants.
Overview
Miller KM et al.. Diabetes Care 2013 · PMID 23378621 · DOI 10.2337/dc12-1770
Among 20,555 people with type 1 diabetes, those who checked blood sugar more often had lower HbA1c.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Relate glucose testing frequency to HbA1c.
- How was the study done?
Registry analysis.
- How many people, animals or samples were studied?
20,555 people.
- What was actually found?
More checks, lower HbA1c.
- How large was the observed effect?
Not in abstract.
- What do the results mean in everyday life?
Measuring helps people on insulin manage diabetes.
- What are the study's limitations?
Observational.
- What does it say about Elawady's specific claim?
Contradicts 'no need to measure glucose'.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot prove causation.
Scientific in-depth review
1. Full reference
- Authors
- Miller KM et al.
- Journal
- Diabetes Care
- Year
- 2013
- Identifier
- PMID 23378621 DOI 10.2337/dc12-1770
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Non-US government support (record).
2. Research question
Is SMBG frequency associated with HbA1c in T1D?
3. Study design and population
- Study design
- Cross-sectional study – Cross-sectional registry analysis (T1D Exchange)
- Population
People with T1D >=1 year not using CGM
- Country
USA
- Period
Registry
- Sample size
20,555
- Inclusion and exclusion criteria
T1D >=1 year, no CGM
4. Methods and endpoints
- Exposure / intervention
Number of SMBG measurements per day
- Comparator
Lower frequency
- Endpoints
HbA1c
- Statistical methods
General linear models adjusted for confounders
5. Actual results
- Results
After adjustment for race, insurance, income and pump use, more SMBG measurements per day were strongly associated with lower HbA1c (P<0.001) in all age groups and in pump and injection users.
- Absolute risks
not reported
- Authors' conclusion
Strong association between higher SMBG frequency and lower HbA1c.
6. Strengths
- Very large
7. Weaknesses
- Cross-sectional; reverse causation and residual confounding possible
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Observational.
9. Assessment of the statistical interpretation
Association, not proof of causation; effect sizes not in abstract.
10. Relevance to the specific claim
In insulin-treated T1D, more frequent glucose measurement goes with better control.
11. Independent contrary findings
12. Transferability to Germany and Europe
Directly applicable; same biology and clinical standards in Europe.
13. Overall methodological judgement
Consistent observational support for monitoring in T1D.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
15. Linked fact checks
- Laboratory values such as blood glucose and acetone are only signs of the body's changing strategy and not causes; there is no need to measure glucose or blood pressure. – Studies contradicting or limiting the claim