Self-monitoring of blood glucose in diabetes: is it worth it?

Abstract

Self-monitoring of blood glucose (SMBG) is advocated as a valuable aid in the management of diabetes. The volume and cost of monitoring continues to increase. SMBG has a number of theoretical advantages/disadvantages which might impact on treatment, outcome and wellbeing. Investigating and quantifying the effect of self-monitoring in a condition where selfmanagement plays a central role poses major methodological difficulties because of the need to minimize confounding factors. Despite the absence of definitive evidence, some situations where monitoring is generally accepted to be beneficial include patients on insulin, during pregnancy, in patients with hypoglycaemia unawareness and while driving. An area of controversy is the role of monitoring in non-insulin-requiring type-2 diabetes where observational and controlled studies give conflicting results. The available evidence does not support the general use of monitoring by all patients with type-2 diabetes, although further research is needed to identify specific subgroups of patients or specific situations where monitoring might be useful. The best use of SMBG in patients with type-2 diabetes might be for those receiving insulin and those on sulphonylurea drugs. The impact of monitoring on patient wellbeing must also be considered, with some studies suggesting adverse psychological effects. Given the large increase in the prevalence of type-2 diabetes, it will be important to define the role of SMBG so that resources can be used appropriately. Presently, the widespread use of SMBG ( particularly in type-2 diabetes patients) is a good example of self-monitoring that was adopted in advance of robust evidence of its clinical efficacy.

Self-monitoring of blood glucose in type 2 diabetes: systematic review

“…A review by O'Kane and Pickup (2009) 106 comes to a similar conclusion as our review and ends with the comment that 'The widespread use of SMBG (particularly in type-2 patients) is a good example of self-monitoring that was adopted in advance of robust evidence of it clinical efficacy'. Their review provides a useful history of SMBG and the technical aspects.…”

“…There is also a passionate argument from patient groups and the pharmaceutical industry that SMBG for individuals with T2DM should not be withdrawn. O'Kane and Pickup (2009) 106 perhaps aptly declared that 'present widespread use of SMBG in T2DM is a good example of a monitoring test that was adopted in advance of robust evidence of its clinical efficacy'. Thus identification of potential subgroups of those patients who would receive the most benefit from SMBG should be identified, perhaps by some qualitative work to identify characteristics of those most likely to benefit (which may be about patient attributes rather than treatment) followed by a RCT.…”

The use of high-definition video technology on diabetes management

“…and scoring system ranged from (1 = not performed, 2 = performed, 3 = performed well, 4 = performed excellent). [25] Tool four: Diabetic child's investigations' results (fasting blood glucose level, postprandial blood glucose level and Glycosylated hemoglobin level) were collected from child's medical record.…”

The evidence base for laboratory medicine: more work needed

“…The choice of the clinical outcomes to be evaluated also requires careful consideration and might include broader aspects of wellbeing such as the psychological impact of testing on subjects which may be particularly important in patients undertaking self-testing as part of chronic disease management. 3 It will be apparent that test-treatment RCTs are complex in design, may require large numbers of participants to attain adequate statistical power for the selected clinical endpoints and are therefore expensive to undertake. Alternative approaches include mathematical modelling which integrates results from diagnostic accuracy studies into clinical algorithms and computes outcomes.…”