Comment on: Davidson MB (2007) The dilemma of self-monitoring of blood glucose. Diabetologia 50:497–499

Myocardial Infarction and Stroke in Early Years After Diagnosis of Type 2 Diabetes: Risk Factors and Relation to Self-Monitoring of Blood Glucose

“…Previous analyses of the total ROSSO cohort had revealed that mean HbA1c levels were higher by 0.4-0.5% in patients using SMBG than in patients not using SMBG. 6 This finding is in line with observations from other observational studies 20,21 and indicates that insufficient glycemic control is one of the main reasons to initiate SMBG. In the period before a macrovascular event the difference in glycemic control in relation to the use of SMBG is even more pronounced: it has doubled from 0.4-0.5% to 0.9-1.0%.…”

Response to comment on: Davidson MB (2007) The dilemma of self-monitoring of blood glucose. Diabetologia 50:497–499

“…I do agree that SMBG values have no direct effect on glycaemia [1]; appropriate action leading to better control based on these results is necessary. However, as pointed out previously [2], immediate actions in patients not taking insulin are limited and longer term behavioural changes have, for the most part, not materialised.…”

“…To the Editor: After several long discussions at meetings concerning self-monitoring of blood glucose (SMBG) in diabetic patients not taking insulin, A. J. Karter and I agree to disagree. I will respond briefly to the points raised in his letter [1].…”

“…Most patients were not taking insulin. Regarding the point raised about intensive nurse case management [1], the 40 intervention patients in this study were serviced by three endocrinologists (a professor and two clinical instructors), a nurse and a dietitian. The two clinical instructors logged on to the system daily and sent appropriate recommendations every 2 weeks (based on the Staged Diabetes Management Protocols, with any changes in medication cleared by the professor).…”