DOC News January 1, 2005
Volume 2 Number 1 p. 11
© 2005 American Diabetes Association
Self-Monitoring May Help Patients with Non–Insulin-Treated Type 2 Diabetes
Bruce Goldfarb
People with type 2 diabetes who aren't dependent on insulin may still
benefit from regular at-home use of blood glucose monitoring, according to a
recently reported meta-analysis.
When part of a multi-component diabetes management regimen, self-monitoring
of blood glucose (SMBG) results in almost twice the reduction in glycated
hemoglobin (A1C) compared with levels for patients on a regimen that doesn't
include SMBG, according to Nemencio A. Nicodemus, Jr., MD, and colleagues at
the University of the Philippines and Manila-based Applied Research
Consultancy, Inc.
"We found an additional 45% reduction in A1C from
self-monitoring," says Nicodemus, who presented the group's findings at
the American Academy of Family Physicians (AAFP) Scientific Assembly held in
Orlando, Fla.
Although SMBG is usually practiced by patients with diabetes who require
insulin, some, including the American Diabetes Association, suggest that
self-monitoring ought to be a useful guide for those who manage their disease
with diet, exercise, and oral hypoglycemic agents.
A smattering of studies suggest that SMBG is associated with better
glycemic control, but "one prior meta-analysis showed no benefit,"
explains Nicodemus. "We were puzzled by
that."1
The group conducted a meta-analysis of its own, searching databases and the
literature to find eight randomized, controlled clinical trials on adult
patients with non–insulin-treated type 2 diabetes that compared A1C
reduction with and without SMBG.
The eight trials comprised a total of 1,307 patients. Although the
self-monitoring strategies ranged in frequency from 3 to 12 times per week,
the authors say that heterogeneity among the studies was not statistically
significant.
SMBG by itself does not improve glycemic control, but works best as part of
multi-component diabetes management, says epidemiologist and statistician
Jesus N. Sarol, Jr., lead investigator of the meta-analysis.
Sarol says that it's too soon to recommend SMBG to patients not using
insulin. "Personally, I would like to see more studies specifically on
cost-benefit and optimal strategies for self-monitoring," he says.
References
1. Coster S, Gulliford MC, Seed PT, Powrie JK, Swaminathan R:
Self-monitoring in type 2 diabetes mellitus: a meta-analysis.
Diabet Med 17:755–761, 2000.[Medline]
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