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Benefits of glucose self-monitoring in non-insulin treated type 2 diabetes debated

By Bianca Nogrady
Researchers studying glucose self-monitoring in people with type 2 diabetes not treated with insulin have questioned whether the practice has any benefits in blood glucose control.

A one-year study comparing self-monitoring, with or without automatic tailored messages, and a control of no self-monitoring, in 450 individuals with non-insulin-treated type 2 diabetes found no significant differences in glycated haemoglobin (HbA1c) levels nor health-related quality of life measures after 12 months.

However, Associate Professor Sof Andrikopoulos, CEO of the Australian Diabetes Society, pointed out that there was an effect earlier in the study when patients were more adherent to the self-monitoring regimen.

The study, published in JAMA Internal Medicine, also showed no significant differences between the three arms in rates of insulin initiation, the incidence of hypoglycaemia or healthcare utilisation.

The authors of the study said their results echoed earlier studies suggesting that self-monitoring in this group had limited usefulness.

‘This null result occurred despite training participants and primary care clinicians on the use and interpretation of the meter results,’ the authors wrote, arguing that self- monitoring should not be routine for most patients with non-insulin-treated type 2 diabetes.

Speaking to Medicine Today, Professor Andrikopoulos pointed out that at three, six and nine months into the study, there were significant differences in mean HbA1c levels between the self-monitoring and no-monitoring arms.

‘So you do get an effect earlier in the study, when most people are self-monitoring, and those who are measuring their blood sugar actually have a better HbA1c than those who don’t,’ Professor Andrikopoulos said.

Patients with non-insulin-dependent type 2 diabetes should be encouraged to self-monitor at least weekly, he said, and at different times of the day to understand how different activities and types of meals influence their blood sugar levels.

‘The intention is that they should have some idea of how they’re travelling with their blood sugar levels on a regular basis so that they can make adjustments as they require to achieve optimal HBA1c levels,’ he said.

The study’s authors also noted that their research was not powered to examine the effectiveness of self-monitoring versus no monitoring in certain clinical situations, such as when starting a new medication or changing dose.
JAMA Intern Med 2017; doi:10.1001/jamainternmed.2017.1233.

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