- The efficacy of self-monitoring of blood glucose in patients with newly diagnosed type-2 diabetes (ESMON) randomised controlled trial found that newly diagnosed type-2 diabetics were unlikely to gain additional benefits from monitoring themselves (BMJ 2008; 336: 1,174-7).
- An economic analysis of data from the diabetes glycaemic education and monitoring (DiGEM) randomised controlled trial showed that for patients with non-insulin treated type-2 diabetes, intensive self-monitoring of blood glucose (SMBG) approximately doubles the costs of monitoring with no improvement in glycaemic control and actually with a decrease in quality of life (BMJ 2008; 336: 1,177-80).
- An Australian study has shown that there was no significant difference in HbA1c levels between those who did home monitoring and those who did not (Diabetes Care 2006; 29: 1,764-70).
- A qualitative study has shown that patients actually find it difficult to interpret self-monitoring and few patients use it as a way to change their behaviour and lifestyle (BMJ 2007; 335: 493-6).
- A randomised trial found that SMBG did not improve glycaemic control in reasonably well controlled non-insulin treated patients with type-2 diabetes compared with usual care (BMJ 2007; 335: 132-6).
- Patients should be properly trained in the use of blood glucose monitoring systems and should take appropriate action on the results obtained (British National Formulary, London; BMJ Group 2008).
- A Cochrane review concluded that SMBG might be effective in improving glycaemic control in patients with type-2 diabetes who are not using insulin, but more trials are needed (Cochrane Database Syst Rev 2005;(2):CD005060).
- The National Prescribing Centre states that routine SMBG is unlikely to be beneficial in patients with type-2 diabetes who are not treated with insulin (MeReC Extra Issue 2008; 34).
- NICE recommends SMBG should be offered to patients newly diagnosed with type-2 diabetes as an integral part of self-education. It should also be available to those on insulin.
- The SMBG working group found rates of SMBG in type-2 diabetic patients was high in non-insulin-treated patients with variations between different countries (Diabetes Res Clin Pract 2008; 82: e15-8).
- An American Diabetes Association and the European Association for the Study of Diabetes statement suggested self-monitoring is not needed for regimens that do not include sulphonylureas (Diabetes Care 2006; 29: 1,963-72).
Contributed by Dr Louise Newson, a GP in the West Midlands
- Role of SMBG is uncertain for type-2 diabetics.
- Regular HbA1c testing may be as effective.
- Studies show conflicting results.
- Rates of SMBG vary between countries.