Current guidelines for blood glucose self-monitoring should be reviewed

A new study published on bmj.com questions the value of blood glucose monitoring among patients with well-controlled, non-insulin dependent (type 2) diabetes.

The research, presented at the American Diabetes Association Conference, suggests that current guidelines for self-monitoring among these patients should be reviewed.

Non-insulin dependent (type 2) diabetes usually develops in people over 40, especially when the person is overweight. In most cases, insulin injections are not needed. Instead, a combination of dietary measures, weight reduction, and oral medication controls the condition.

Self monitoring for type 2 diabetes is costly, but many doctors believe that it helps to control blood glucose levels and it is commonly recommended. Although some studies have suggested benefits, evidence of effectiveness is still inconclusive.

So Dr Andrew Farmer and colleagues set out to test whether self-monitoring can improve blood glucose control in non-insulin using patients compared with standard care.

They identified 453 non-insulin using type 2 diabetes patients from 48 general practices.

Patients were randomly assigned to one of three groups. The control group received standard care with three-monthly HbA1c measurements by a health professional (a measure of the amount of glucose attached to red blood cells).

The second group was given a meter with advice to contact their clinician for interpretation of results (less intensive self-monitoring), while the third group was given a meter and trained to interpret the readings and apply the results (more-intensive self monitoring).

At 12 months, there was no difference in HbA1c between the groups. There was also no evidence that intensity of monitoring was related to improvements in glucose control.

This trial provides no convincing evidence of an effect of blood glucose monitoring, with or without instruction, in improving glucose control compared with usual care, say the authors.

Routine self-monitoring of blood glucose for reasonably well-controlled non-insulin treated patients with type 2 diabetes appears to offer, at best, small advantages, is not well accepted, and the cost, effort and time involved in the procedures may be better directed to supporting other health-related behaviours, they add.

They suggest that current guidelines for the use of self-monitoring among these patients should be reviewed.

http://www.bmj.com