Counterpoint: Self-Monitoring of Blood Glucose in Type 2 Diabetic Patients not Receiving Insulin

Davidson, Mayer B.

doi:10.2337/diacare.28.6.1531

Cited by 102 publications

(73 citation statements)

References 26 publications

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“…12,13 However, a growing body of evidenceresulting from several meta-analyses-suggests that SMBG has a positive effect on metabolic control, independent of the type of antidiabetic treatment (oral antidiabetic drugs only or in combination with insulin).…”

Section: Discussionmentioning

confidence: 99%

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

Kolb

Schneider

Heinemann

et al. 2008

J Diabetes Sci Technol

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Background: The incidence of type 2 diabetes is increasing disproportionately in individuals <65 years of age. It is not known whether disease characteristics in these younger patients are similar to “classic” late-onset type 2 diabetes. Methods: In the epidemiological cohort study entitled “Retrolective Study: Self-Monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes,” a total of 3268 patients from randomly contacted primary care practices were documented during a mean follow-up period of 6.5 years. All newly diagnosed patients of these practices were included. Results: At diagnosis, 64.2% of the patients were aged ≤65 years. Thereof, 57.2% were male, whereas in the age group >65 years only 35.0% were male ( p < 0.001). The younger group exhibited more severe metabolic deterioration at diagnosis and in the following years than the older group. Conversely, the older group presented at diagnosis with a higher prevalence of cardiovascular risk factors. Self-monitoring of blood glucose (SMBG) was more prominent in the younger group. In both age groups, the use of SMBG was associated with a significantly lower risk ( p = 0.003) of a combined end point (severe diabetic complication or all-cause mortality). Conclusions: There are considerable differences in disease characteristics between people diagnosed with type 2 diabetes during 45–65 years of age versus diagnosis at a later age. Type 2 diabetes diagnosed before the age of 65 years disproportionately affected men and exhibited a more severe disease course, but was characterized by significantly less cardiovascular risk factors in comparison to type 2 diabetes diagnosed at a later age. The use of SMBG was associated with a better clinical outcome in both age groups.

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Section: Discussionmentioning

confidence: 99%

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

Kolb

Schneider

Heinemann

et al. 2008

J Diabetes Sci Technol

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“…Both meta-analyses concluded that multi-component treatment strategies produced significantly greater reductions in HbA 1 c levels when SMBG was included. The arguments for and against SMBG in patients with type 2 diabetes were recently summarised [20,21]. Unfortunately, none of the prospective studies was extended over a period of several years, precluding analysis of clinical endpoints.…”

mentioning

confidence: 99%

Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study

et al. 2005

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Aims/hypothesis: The aim of this study was to obtain epidemiological data on self-monitoring of blood glucose (SMBG) in type 2 diabetes and to investigate the relationship of SMBG with disease-related morbidity and mortality. Methods: The German multicentre Retrolective Study 'Self-monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes' (ROSSO) followed 3,268 patients from diagnosis of type 2 diabetes between 1995 and 1999 until the end of 2003. Endpoints were diabetesrelated morbidity (non-fatal myocardial infarction, stroke, foot amputation, blindness or haemodialysis) and all-cause mortality. SMBG was defined as self-measurement of blood glucose for at least 1 year. Results: During a mean followup period of 6.5 years, 1,479 patients (45.3%) began SMBG prior to an endpoint and an additional 64 patients started SMBG after a non-fatal endpoint. Interestingly, many patients used SMBG while being treated with diet or oral hypoglycaemic drugs (808 of 2,515, 32%). At baseline, the SMBG cohort had higher mean fasting blood glucose levels than the non-SMBG cohort (p<0.001), suggesting that insufficient metabolic control was one reason for initiating SMBG. This was associated with a higher rate of microvascular endpoints. However, the total rate of nonfatal events, micro-and macrovascular, was lower in the SMBG group than in the non-SMBG group (7.2 vs 10.4%, p=0.002). A similar difference was found for the rate of fatal events (2.7 vs 4.6%, p=0.004). Cox regression analysis identified SMBG as an independent predictor of morbidity and mortality, with adjusted hazard ratios of 0.68 (95% CI 0.51-0.91, p=0.009) and 0.49 (95% CI 0.31-0.78, p=0.003), respectively. A better outcome for both endpoints was also observed in the SMBG cohort when only those patients who were not receiving insulin were analysed. Conclusions/interpretation: SMBG was associated with decreased diabetes-related morbidity and all-cause mortality in type 2 diabetes, and this association remained in a subgroup of patients who were not receiving insulin therapy. SMBG may be associated with a healthier lifestyle and/or better disease management.

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“…Response to Fadini and Avogaro R ecently, our pilot study provided evidence that autologous transplantation of granulocyte colonystimulating factor-mobilized peripheral blood mononuclear cells (PBMNCs) may represent a simple, safe, effective, and novel therapeutic approach for diabetic critical limb ischemia (CLI) (1). In our study, we chose diabetic patients with proven CLI, but without hypercoagulable states and/or severe coronary, cerebral, and renal vascular disease.…”

Section: Transplantation Of Granulocyte Colonystimulating Factormobilmentioning

confidence: 99%

Autologous Transplantation of Granulocyte Colony–Stimulating Factor–Mobilized Peripheral Blood Mononuclear Cells Improves Critical Limb Ischemia in Diabetes

2006

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Counterpoint: Self-Monitoring of Blood Glucose in Type 2 Diabetic Patients not Receiving Insulin

Cited by 102 publications

References 26 publications

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

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

Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study

Autologous Transplantation of Granulocyte Colony–Stimulating Factor–Mobilized Peripheral Blood Mononuclear Cells Improves Critical Limb Ischemia in Diabetes

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