Journals club - Self-monitoring of blood glucose in type-2 diabetes

Curriculum statement 15.6 Metabolic problems Key trials

  • 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).

Evidence base

  • 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).

Guidelines

  • 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

Key points

  • 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.

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