Prescribing Advice for GPs

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Glycaemic control not improved by SMBG

The British Medical Journal has published the results of a study that aimed to assess the impact of self monitoring of blood glucose (SMBG) on HbA1c.

The study recruited 453 patients with type 2 diabetes controlled by diet or oral medication. The patients were randomly assigned to open treatment with standard care in the control group or one of two intervention arms consisting of SMBG with medical advice or SMBG with training on interpretation of the results. The patients were followed up every 3 months for 1 year.

Approximately one third of the patients in each of the intervention groups failed to persist with the monitoring for the duration of the study. The data were analysed on an intention to treat basis.

There were no differences in HbA1c between any groups at 12 months after correction for baseline levels. There was a statistically significant decrease in total cholesterol in the group using SMBG with training. Since the primary outcome was not significant this finding should be interpreted with caution.

It was also noted that significantly more patients in the intervention arms of the study experienced episodes of grade 2 hypoglycaemia defined as "mild symptoms requiring minor intervention".

The authors conclude that SMBG, for reasonably well controlled patients with type 2 diabetes, offers little in terms of advantage while it is poorly tolerated by patients. It is also suggested that the cost, time and effort involved could be better used in alternative areas of healthcare provision.

Action: Clinicians should consider the place of SMBG for their patients and avoid routinely recommending this intervention for reasonably well controlled patients with type 2 diabetes controlled by diet or oral medication.

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One Comments to “Glycaemic control not improved by SMBG”

  1. [...] use of self monitoring decreases over time and they find results difficult to interpret and act on. Previous studies have identified that SMBG does not improve glycaemic [...]

    Pingback by Prescribing Advice For GPs » Patients Confused By Diabetes Testing — April 25, 2008 #
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