MRCGP Exam Update - Self-monitoring of glucose

CURRENT SITUATION 

- The Diabetes Control and Complications Trial and the UK Prospective Diabetes Study have confirmed the importance of normoglycaemia for the subsequent prevention of diabetic complications.

- Self-monitoring of blood glucose, hailed as one of the most important developments in diabetes care since the discovery of insulin, costs the NHS over £120 million each year (Diabet Med 2005; 22: 511).

- The role of self-monitoring for patients with type-2 diabetes who are not receiving insulin is still under debate.

WHAT IS THE EVIDENCE?

- 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, Diabetes Care 2002; 25: 245).

- These results may merely indicate that those who are highly motivated (as reflected in the uptake of the opportunity to self-monitor) are likely to do well in the long term (Diabet Med 2005; 22: 1).

- A qualitative study found that patients believed that blood testing was reserved for those whose diabetes was particularly severe (Diabet Med 2004: 21: 1,045).

- In a large study of non-insulin-treated patients with type-2 diabetes, the performance and frequency of SMBG did not predict better control over a three year period (Diabet Med 2005; 22: 900).

- A good-quality systematic review following Cochrane methodology identified six relevant randomised controlled trials that fulfilled their pre-determined quality standards (Diabetes Care 2005; 28; 1,510-51).

The overall effect was for self-monitoring to lower HBA1c by 0.39 per cent, which the authors felt was a clinically significant benefit.

- For people with diabetes controlled with diet and tablets, glycaemic control could be monitored more cost-effectively by using HbA1c alone, measured at three to four monthly intervals (BMJ 2004; 329: 754).

AVAILABLE GUIDELINES

- NICE has supported the use of home blood glucose monitoring in type-2 diabetes, although it indicated that this should be part of integrated self care and 'if the purpose... is agreed with the patient'.

- A multidisciplinary group of healthcare professionals published consensus advice on home blood glucose monitoring (Diabetes Primary Care 2004; 6: 8).

The group agreed that monitoring was not required routinely in type-2 diabetes but suggested it was used in special circumstances (during intercurrent illnesses, when oral hypoglycaemic treatment is changed, if systemic glucocorticoids are prescribed and if post-prandial hyperglycaemia occurs).

USEFUL WEBSITES
www.nice.org.uk - NICE
www.diabetes.org.uk - Diabetes UK

KEY POINTS
- Role of blood glucose self-monitoring is still uncertain.
- Regular HbA1c testing may be as effective.
- Studies show conflicting results.

Dr Louise Newson is a GP in the West Midlands and author of 'Hot Topics for MRCGP and General Practitioners', Pas Test 2006.

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