Doubts over DIY glucose monitoring
THE clinical benefits and cost-effectiveness of non-insulin treated type 2 diabetes patients monitoring their own blood glucose has been thrown into doubt by two studies showing it failed to improve glycaemic control and adversely affected quality of life.
A UK randomised trial involving 184 people with newly diagnosed type 2 diabetes found no significant difference in HbA1c levels or the incidence of hypoglycaemia after comparing patients who undertook blood glucose measurements eight times a week for one year with a non-monitoring group.
Self-monitoring was also associated with higher levels of reported depression and anxiety (BMJ, online 17 April).
“The negative effect might relate less to feelings of powerlessness in the face of high blood glucose readings than to the enforced discipline of regular monitoring,” the authors said.
A prospective economic analysis among 453 patients with non-insulin treated type 2 diabetes also found self-monitoring was significantly more expensive than routine care. Researchers estimated intensive self-monitoring cost an additional $195 per patient every year.
Professor Duncan Topliss, director, Department of Endocrinology and Diabetes at The Alfred Hospital in Melbourne said: “These... clearly show that we do need to rethink slavish use of this technique.”
He described HbA1c as a “good surrogate marker” for long-term microvascular outcomes and advocated HbA1c over self-monitoring in most non-insulin type 2 diabetes patients.
An accompanying editorial said self-monitoring and might carry an “opportunity cost” with attention better directed to more effective disease control measures such as blood pressure control and smoking cessation.
However, he said until a large randomised trial was conducted, GPs should discuss the value of self-monitoring on a patient-by-patient basis.
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