Role of self monitoring in patients with type 2 diabetes

A new study published on bmj.com calls for better advice about home blood glucose monitoring for patients with non-insulin dependent (type 2) diabetes.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.

Some experts believe that daily self monitoring helps to control blood glucose levels and it is often recommended. But others believe that self monitoring is complex and inconvenient and can lead to feelings of frustration and guilt. As such, there is still no firm agreement about the role and value of self monitoring for patients with type 2 diabetes.

So Dr Elizabeth Peel and colleagues interviewed 18 patients with newly diagnosed type 2 diabetes over four years to explore their views about self monitoring over time.

They found that self monitoring decreased over time, and those who did continue monitoring did so less frequently. Some patients expressed uncertainty about the meaning of the test results and how to act on them, while others found self monitoring to be reassuring.

How to act on high readings was a consistent problem.

Most patients also voiced concerns about the value health professionals placed on their readings. Doctors generally appeared to show little interest in patients' test results after the initial phase, leading some patients to see self monitoring as not very important or even pointless.

Interestingly, some patients continued to self monitor despite lack of guidance and the perceived disinterest from health professionals.

Clinical uncertainty about the role of self monitoring in patients with type 2 diabetes is mirrored in patients' own accounts, say the authors. Patients tended not to act on their self monitoring results, in part because of a lack of education and dialogue about the appropriate response to readings.

They urge health professionals to be explicit about whether and when such patients should self monitor and how they should interpret and act upon the results, especially high readings.