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Blood glucose self-monitoring in type 2 diabetes: a randomised controlled trial.
A J Farmer1, A N Wade, D P French
1Department of Primary Health Care, NIHR School of Primary Care Research, University of Oxford, UK.
Health Technology Assessment (Winchester, England)
|March 4, 2009
Summary
Self-monitoring of blood glucose (SMBG) did not significantly improve glycaemic control in non-insulin-treated type 2 diabetes patients compared to usual care. Routine SMBG is not recommended due to lack of proven benefit and potential increased costs.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Clinical Trials
Background:
- Type 2 diabetes management often involves monitoring blood glucose levels.
- The effectiveness of self-monitoring of blood glucose (SMBG) in non-insulin-treated patients requires further investigation.
Purpose of the Study:
- To compare the efficacy of SMBG, with or without enhanced self-care instruction, against usual care for improving glycaemic control.
- To assess the impact of SMBG on secondary outcomes including blood pressure, lipids, and quality of life.
Main Methods:
- An open, parallel-group randomized controlled trial involving 453 non-insulin-treated type 2 diabetes patients.
- Patients were randomized to: usual care, less intensive SMBG (clinician interpretation), or more intensive SMBG (patient interpretation and self-care application).
- Primary outcome was HbA1c at 12 months; secondary outcomes included blood pressure, lipids, and quality of life (EQ-5D).
Main Results:
- No statistically significant difference in HbA1c levels at 12 months was observed between the SMBG groups and the usual care group (p=0.12).
- SMBG did not demonstrate a significantly different impact on glycaemic control across various patient subgroups.
- Economic analysis indicated SMBG resulted in higher healthcare costs without clear cost-effectiveness, and an initial negative impact on quality of life was noted.
Conclusions:
- SMBG, with or without enhanced self-care training, did not significantly improve glycaemic control in non-insulin-treated type 2 diabetes patients compared to usual care.
- There is no convincing evidence to support routine SMBG for all patients in this population.
- Potential benefits for specific subgroups warrant further investigation, but routine implementation is not supported by current data.
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