Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial

Farmer, Andrew; Wade, Alisha; Goyder, Elizabeth; Yudkin, Patricia; French, David P.; Craven, Anthea; Holman, Rury R.; Kinmonth, Ann Louise; Neil, Andrew

doi:10.1136/bmj.39247.447431.be

Cited by 363 publications

(337 citation statements)

References 26 publications

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“…Their mean HbA 1c was, however, 1% higher than that reported by more recent studies on individuals with type 2 diabetes managed in the community [6]. Compared with other sources of UK primary care data, the measurements for the LDS population indicated that participants included in this study tended to be younger and had a longer duration of diabetes [7]. As well as population changes in HbA 1c and blood pressure, death from CVD has also declined in men (but not women) with diabetes over the last 30 years, possibly as a result of improvements in lifestyle and the treatment of CVD [8].…”

Section: Discussioncontrasting

confidence: 69%

Impact of using a non-diabetes-specific risk calculator on eligibility for statin therapy in type 2 diabetes

et al. 2008

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Aims/hypothesis The aim of this study was to investigate the impact of using a non-diabetes-specific cardiovascular disease (CVD) risk calculator to determine eligibility for statin therapy according to current UK National Institute for Health and Clinical Excellence (NICE) guidelines for those patients with type 2 diabetes who are at an increased risk of CVD (10 year risk ≥20%). Methods The 10 year CVD risks were estimated using the UK Prospective Diabetes Study (UKPDS) Risk Engine and the Framingham equation for 4,025 patients enrolled in the Lipids in Diabetes Study who had established type 2 diabetes and LDL-cholesterol <4.1 mmol/l. Results The mean (SD) age of the patients was 60.7 (8.6) years, blood pressure 141/83 (17/10) mmHg and the total cholesterol:HDL-cholesterol ratio was 3.9 (1.0). The median (interquartile range) diabetes duration was 6 (3-11) years and the HbA 1c level was 8.0% (7.2-9.0%). The cohort comprised 65% men, 91% whites, 4% Afro-Caribbeans, 5% Asian Indians and 15% current smokers. More patients were classified as being at high risk by the UKPDS Risk Engine (65%) than by the Framingham CVD equation (63%) (p<0.0001). The Framingham CVD equation classified fewer men and people aged <50 years old as high risk (p<0.0001). There was no difference between the UKPDS Risk Engine and Framingham classification of women at high risk (p=0.834). Conclusions/interpretation These results suggest that the use of Framingham-derived rather than UKPDS Risk Engine-derived CVD risk estimates would deny about one in 25 patients statin therapy when applying current NICE guidelines. Thus, under these guidelines the choice of CVD risk calculator is important when assessing CVD risk in patients with type 2 diabetes, particularly for the identification of the relatively small proportion of younger people who require statin therapy.

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Section: Discussioncontrasting

confidence: 69%

Impact of using a non-diabetes-specific risk calculator on eligibility for statin therapy in type 2 diabetes

et al. 2008

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“…Indeed, the present study shows that patients who realize the importance of carrying out SMBG testing are more willing to share SMBG results with their physicians, and that patients realize the importance of carrying out SMBG testing and sharing SMBG results with their physicians more when physicians regularly check patients’ SMBG results to provide meaningful feedback. Previous studies have shown that appropriate SMBG use under instructions from healthcare professionals improved glycemic control and well‐being in type 1 diabetes patients16 and also in non‐insulin treated type 2 diabetes patients17, 18, whereas others have failed to show significant benefits19, 20. As the present study shows that physicians’ regular check of patients’ SMBG results affects patients’ attitude to SMBG use, sharing SMBG results between patients and healthcare professionals could play a critical role in making better use of SMBG to improve glycemic control in type 1 diabetes and type 2 diabetes patients.…”

Section: Discussionmentioning

confidence: 99%

Mental distress and health‐related quality of life among type 1 and type 2 diabetes patients using self‐monitoring of blood glucose: A cross‐sectional questionnaire study in Japan

Tanaka

Yabe

Murotani

et al. 2018

J of Diabetes Invest

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Aims/IntroductionThe present multicenter, cross‐sectional survey was initiated to evaluate self‐monitoring of blood glucose (SMBG)‐associated mental distress among patients with diabetes.Materials and MethodsThe survey was carried out in patients with type 1 diabetes and type 2 diabetes using SMBG recruited from 42 medical institutions. Profiles of Mood States 2 and diabetes therapy‐related quality of life questionnaires were used to evaluate mood status and health‐related quality of life. Two original questionnaires were also developed to evaluate SMBG ‘importance,’ ‘painfulness’ and ‘confidence’ among patients, and to evaluate physician attitudes to SMBG use.ResultsQuestionnaires from 517 type 1 diabetes and 1,648 type 2 diabetes patients showed that 46.0% of type 1 diabetes and 37.5% of type 2 diabetes patients reported ‘painfulness,’ and that these patients reporting ‘painfulness’ showed significantly higher Profiles of Mood States 2 scores, lower diabetes therapy‐related quality of life scores and higher glycated hemoglobin compared with those not reporting ‘painfulness,’ whereas the number of their daily SMBG tests were comparable. Patients reporting ‘painfulness’ also reported that SMBG use was significantly less important. Whether or not patients recognized the importance of SMBG use was well correlated with the frequency of physicians checking patient diaries.ConclusionsType 1 diabetes and type 2 diabetes patients reporting ‘painfulness’ in SMBG use had more mental distress, lower health‐related quality of life and higher glycated hemoglobin regardless of their number of daily SMBG tests. The importance of SMBG use was recognized less by patients experiencing pain, and the importance of SMBG use was recognized more in medical institutions in which physicians regularly checked SMBG diaries to provide meaningful feedback to patients in clinical settings.

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“…However, lifestyle stabilization is inconsistent with maintaining a high quality of life, which is the main goal of treatment in diabetic patients. In the Diabetes Glycemic Education and Monitoring study carried out in non‐insulin‐treated patients with type 2 diabetes, HbA1c levels at 12 months failed to improve in three groups of patients: (i) patients who did not carry out SMBG; (ii) patients with more intensive SMBG, and (iii) patients with SMBG alone17. The results of that study show that SMBG is not a simple routine method to measure blood glucose level, and it can become useful only when feedback from the results is incorporated into self‐care.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing inter‐day glycemic variability in diabetic outpatients receiving insulin therapy

Mori

Okada

Kurozumi

et al. 2016

J of Diabetes Invest

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IntroductionThe aim of the present study was to determine the actual state of inter‐day glycemic variability and identify the factors that affect glycemic variability in diabetic outpatients on insulin therapy.Materials and MethodsThe participants were 45 outpatients with diabetes mellitus receiving insulin therapy. The mean plasma glucose (MPG) levels, intra‐day glycemic variability (expressed by standard deviation and mean amplitude of glucose excursion) and inter‐day glycemic variability (expressed by mean of daily differences [MODD] in blood glucose levels) were measured continuously over 7 days with iPro2®. The primary outcome was the relationship between MODD and the life variability index.Results MODD values were high in 93.3% of the participants, and significantly higher in patients with lifestyle changes than in those without (higher in patients with high life variability index). MODD values were not associated with age, but significantly higher in women. MODD values correlated significantly with glycated hemoglobin and glycoalbumin levels, and negatively with 1,5‐anhydroglucitol levels. MODD values were significantly higher in type 1 diabetes patients and not associated with duration of disease. MODD values correlated significantly with insulin dose. Multivariate analysis identified the life variability index as a significant determinant of MODD.ConclusionsiPro2® provided detailed information on glycemic profile in diabetic outpatients receiving insulin therapy. The results suggest that patients with large inter‐day glycemic variability are unlikely to achieve an improvement in their glycated hemoglobin level. Treatment and instructions based on a patient's characteristics, day‐to‐day glycemic variability and lifestyle are important to achieve good glycemic control.

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Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial

Cited by 363 publications

References 26 publications

Impact of using a non-diabetes-specific risk calculator on eligibility for statin therapy in type 2 diabetes

Impact of using a non-diabetes-specific risk calculator on eligibility for statin therapy in type 2 diabetes

Mental distress and health‐related quality of life among type 1 and type 2 diabetes patients using self‐monitoring of blood glucose: A cross‐sectional questionnaire study in Japan

Factors influencing inter‐day glycemic variability in diabetic outpatients receiving insulin therapy

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