Is Self-Monitoring of Blood Glucose Appropriate for All Type 2 Diabetic Patients?

Abstract

OBJECTIVE -We sought to determine whether self-monitoring of blood glucose (SMBG) is associated with better glycemic control in type 2 diabetes.RESEARCH DESIGN AND METHODS -We used cross-sectional and longitudinal data from type 2 diabetic participants in the observational, community-based Fremantle Diabetes Study (FDS) who reported SMBG status at study entry (n ϭ 1,286) and annual reviews over 5 years (n ϭ 531).RESULTS -At study entry, 70% of patients performed SMBG, with a median of four tests per week (interquartile range two to seven). Patients with shorter diabetes duration; who were attending diabetes education, diabetes-related clinics, or medical specialists; who were taking insulin with or without oral hypoglycemic agents (OHAs); and who were self-reporting hypoglycemic events were more likely to use SMBG. Both cross-sectional and longitudinal FDS data showed that HbA 1c (A1C) was not significantly different between SMBG users and nonusers, either overall or within diabetes treatment groups (diet, OHAs, and insulin with or without OHAs). There was also no independent cross-sectional relationship between A1C and SMBG frequency. The average annual societal cost of using SMBG (in year 2000 Australian dollars [A$], excluding glucometers) was A$162 per type 2 diabetic patient or A$51 million when projected to the Australian diagnosed type 2 diabetic population.CONCLUSIONS -Neither SMBG testing nor its frequency was associated with glycemic benefit in type 2 diabetic patients regardless of treatment. Our data did not include methods of SMBG delivery and application, factors that require further assessment in the evaluation of SMBG utility in non-insulin-treated type 2 diabetes. SMBG may be still of value in the identification and prevention of hypoglycemia and in dose adjustment in insulin-treated patients. Diabetes Care 29:1764 -1770, 2006T here is strong evidence that intensive glycemic control cost-effectively reduces chronic, particularly microvascular, complications of type 2 diabetes (1,2). However, the role of selfmonitoring of blood glucose (SMBG) in type 2 diabetes management is less clear (3-5). As well as increasing the burden of self-care, SMBG contributes significantly to diabetes-attributable (6) and total (7) direct health care costs. There is a need for well-designed studies addressing the benefits and cost effectiveness of SMBG in community-based type 2 diabetes. This includes insulin-treated patients for whom SMBG is recommended without substantive supportive evidence (8 -10).Five randomized controlled trials have validly addressed the question of whether SMBG reduces A1C (11-15). Only one had sufficient statistical power to detect a 0.5% A1C difference between intervention and control groups (14), but SMBG was associated with a modest 0.3% A1C reduction in the OHA-treated, poorly controlled patients. Other nonrandomized controlled trial studies have had problems involving design, subject selection, definition of outcomes, and/or use of additional interventions, which question the validity a...

Type 2 Diabetes Phenotype and Progression is Significantly Different if Diagnosed before versus after 65 Years of Age

“…16,17 We find that performing SMBG showed a significant impact on the clinical outcomes in both age groups, although patients performing SMBG and patients not performing SMBG had comparable cardiovascular antecedents.…”

Düzce İlinde İnsülin Kullanmayan Tip 2 Diyabet Hastalarında Kendi Kendine Kan Şekeri İzleminin Klinik Etkinliğinin Değerlendirilmesi: Birinci Basamak Tabanlı Bir Çalışma

“…Schwedes et al suggested that meal-related structured SMBG could improve glycemic control in T2DM treated with non-insulin regimen (27). Franciosi et al reported that SMBG could be an important role in metabolic control if it is an integral part of a wider educational strategy devoted the promotion of patient autonomy (28).…”

Glucose meters: evaluation of the new formulation measuring strips from Roche (Accu-Chek) and Abbott (MediSense)

“…1 Although some studies report neither selfmonitoring of blood glucose (SMBG) testing nor its frequency is associated with glycaemic benefit in type 2 diabetic patients, SMBG may still be of value in the identification and prevention of hypoglycaemia and in assisting with dose adjustments in insulin-treated patients. 2 What is clear is that encouraging SMBG in people with diabetes mellitus results in lower complication rates. 3 As the incidence of diabetes continues to increase, the number of people relying on glucose meters for improved glycaemic control will similarly increase.…”