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Self-Monitoring of Glucose in Type 2 Diabetes

Monitoring had only a minimal effect on glucose control and other measures.

Some patients with type 2 diabetes who do not use insulin nevertheless monitor their blood glucose routinely at home. To determine the effect of self-monitoring, U.K. researchers conducted this randomized trial in patients with reasonably well-controlled diabetes who were not taking insulin. A total of 453 adults (mean age, 66) were assigned to one of three groups: (1) usual care without home glucose monitoring; (2) usual care plus home blood glucose monitoring, with instructions to call the doctor for interpretations of results; or (3) the same as group 2 plus additional training in interpreting blood glucose results.

At baseline, the mean hemoglobin A_1c level was about 7.5%. At 12 months, changes in hemoglobin A_1c levels, adjusted for baseline measures, were not significantly different in the three groups. For nearly all other measures (weight, blood pressure, body-mass index), the differences were also not significant. Total cholesterol levels fell significantly more in group 3 than in groups 2 and 1 (by 15.4 mg/dL, vs. 8.5 mg/dL and 6.2 mg/dL). Significantly more mild hypoglycemic episodes occurred in groups 3 and 2 (43 and 33, vs. 14).

Comment: These patients with type 2 diabetes had fairly well-controlled blood glucose and were not using insulin. Monitoring blood glucose levels — with or without instruction in interpreting the results — had a minimal effect on glucose control (and on other measures). Based on this study, routine self-monitoring of glucose is unnecessary for such patients. However, for patients with less well-controlled diabetes in whom drug therapies are being adjusted, self-monitoring may have value.

— Keith I. Marton, MD

Published in Journal Watch General Medicine July 3, 2007

Citation(s):

Farmer A et al. Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: Open parallel group randomised trial. BMJ 2007 Jun 25; [e-pub ahead of print]. (http://dx.doi.org/10.1136/bmj.39247.447431.BE)