Changes in A1C Levels Are Significantly AssociatedWith Changes in Levels of the Cardiovascular Risk Biomarker hs-CRP Results from the SteP study

OBJECTIVEdThe effect of therapeutic strategies on cardiovascular (CV) disease can be eval-uated by monitoring changes in CV risk biomarkers. This study investigated the effect of a structured self-monitoring of blood glucose (SMBG) protocol and the resulting improvements in glycemic control on changes in high-sensitivity C-reactive protein (hs-CRP) in insulin-naïve patients with type 2 diabetes. RESEARCHDESIGNANDMETHODSdThe Structured Testing Program (STeP) study was a prospective, cluster-randomized, multicenter trial in which 483 poorly controlled, insulin-naïve patients with type 2 diabetes were randomized to active control (ACG) or structured testing (STG) that included quarterly structured SMBG. Changes in A1C, hs-CRP, and glycemic vari-ability (STG subjects only) were measured at baseline and quarterly. RESULTSdReductions in geometric mean hs-CRP values were significantly greater in the STG group at months 3 (P = 0.005), 6 (P = 0.0003), and 12 (P = 0.04) than in the ACG group. STG patients at high CV risk (.3 mg/L) showed significantly greater reductions in hs-CRP levels than ACG patients at high CV risk: 23.64 mg/dL (95 % CI 24.21 to 23.06) versus 22.18 mg/dL (22.93 to21.43), respectively (P = 0.002). There was a strong correlation between reductions i