Self-monitoring in type-2 diabetes

Current situation

  • The Diabetes Control and Complications Trial and UKPDS trial have confirmed the importance of normoglycaemia for preventing diabetic complications.
  • Self-monitoring of blood glucose, hailed as a vitally important development in diabetes management, costs the NHS more than £120 million each year (Diabet Med 2005; 22: 511-2).
  • The role of self-monitoring for patients with type-2 diabetes who are not receiving insulin is still highly debatable.

What is the evidence?

  • Some observational studies have shown that, in patients treated by diet alone, an increased frequency of self-monitoring is associated with better outcomes, including HbA1c and mortality (Diabetes Care 2003; 26: 1,759-63).
  • These results may merely indicate that those who are highly motivated (reflected in the take-up of self-monitoring of blood glucose) are likely to do well in the long term.
  • In a large study of non-insulin-treated type-2 diabetic patients, the performance and frequency of self-monitoring did not predict better control over a three-year period (Diabet Med 2005; 22: 900-6).
  • A quality systematic review following Cochrane methodology identified six relevant randomised controlled trials that fulfilled their predetermined quality standards (Diabetes Care 2005; 28; 1,510-7). The overall effect seen in these trials was that self-monitoring lowered HbA1c by 0.39 per cent, which the authors felt was a clinically significant benefit.
  • An Australian study revealed no significant differences in HbA1c levels between those who did home monitoring and those who did not (Diabetes Care 2006; 29: 1,764-70).

Available guidelines/further reading

  • NICE has supported the use of self-monitoring in type-2 diabetes, although it indicated that this should only be taught as part of 'integrated self-care' and 'if the purpose ... is agreed with the patient'.
  • One small study has demonstrated that patients with type-2 diabetes who use an internet-based glucose-monitoring system have lower HbA1c levels and better glucose control compared with those receiving usual management. However, the internet-based system involved endocrinologists, a nurse and a dietician monitoring the results on a daily basis (Diabetes Care 2006; 29: 2,625-31).

USEFUL WEBSITES

NICE - www.nice.org.uk

Diabetes UK - www.diabetes.org.uk

Dr Louise Newson is a GP in the West Midlands and author of 'Hot Topics for MCRGP and General Practitioners' PasTest 2006

KEY POINTS

  • The role of SMBG is still uncertain for patients with type-2 diabetes.
  • Regular HbA1c testing may be equally effective.
  • Studies show conflicting results.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus