Prescribing Advice for GPs

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Blood glucose monitoring is not beneficial

Self-Monitoring of Blood Glucose (SMBG) does not offer any glycaemic benefit according to a paper published in Diabetes Care.

This study was an observational study of 1,286 patients with Type II diabetes in Freemantle, Western Australia. It included a five-year follow up of 531 of these patients who attended 6 consecutive annual reviews. Comparisons were made between patients who reported performing SMBG and those who did not in an overall cohort and also broken down into three treatment types, namely diet controlled, taking oral hypoglycaemic agents or using insulin.

Over the period studied, HbA1c and fasting plasma glucose did not differ between those who use SMBG and those who do not in all of the groups studied. Additionally, the frequency of monitoring was also examined and again made no difference to glycaemic control.

The paper suggests that SMBG still has a place in prevention and early detection of hypoglycaemia and to aid dose adjustments in patients using insulin. The role of SMBG for improving glycaemic control in patients with Type II diabetes who are controlled by diet or oral hypoglycaemic agents is not supported. The paper goes as far to suggest that, "money and time currently spent on SMBG in non-insulin-treated patients might be better utilized on alternative, proven interventions to improve glycaemic control".

Action: Routine use SMBG should not be recommended to every patient with diabetes. Use should be restricted to where it is likely to be clinically beneficial. This would include Type I diabetes, Type II diabetes treated with regular insulin injections, for early recognition of hypoglycaemia and as an aid to dietary education.

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