Is self monitor of blood sugar levels effective for non-insulin-dependent diabetics?
Diabetes is a major public health problem, with 4 million people in the UK living with the condition and numbers predicted to rise. Diabetics face an increased risk of stroke and heart disease, as well as other health issues.
There is strong evidence to suggest tightly controlling blood sugar levels can help reduce complications and self monitoring of these levels to adjust insulin doses is accepted practice.
Self monitoring (using a testing device) is also used for people with type 2 diabetes who are not treated with insulin, as a potentially useful way to recognise the impact of eating patterns and physical activity and therefore help diabetics to better manage their condition.
The cost of using the technology for this group has become a major and increasing proportion of health care budgets. Despite this, there had been no evidence that self monitoring was actually effective in helping type 2 diabetics without insulin treatment to better manage their blood sugar levels.
What we did
The NIHR funded researchers to compare three groups of groups of patients. Two groups of patients were self monitoring, with one group receiving additional support to teach them how to interpret the results in relation to changes in their lifestyles. The other group were monitored according to the standard practice (regular HbA1c tests, which indicate the blood glucose levels over a three month period).
All the patients were managing their diabetes by diet or oral medication and received information about managing their diabetes, the importance of diet, activity and where necessary, medication.
What we found
There was no significant difference after one year of treatment, meaning there was no evidence to support routine use of self monitoring for non-insulin-dependent type 2 diabetes patients who have no history of poor control.
The findings did suggest further research is needed to determine any clinical benefits within specific subgroups of patients, such as those who have difficulty in regulating their blood glucose levels.
In December 2015, the NICE Guidelines changed to wholly reflect the results of this study: “Do not routinely offer self monitoring of blood glucose levels for adults with type 2 diabetes” (NICE NG 28, 2015).
The International Diabetes Federation (IDF 2009), American Diabetes Association Standards of Medical Care in Diabetes (2013), and the European Society of cardiology and Clinical practice guidelines have all taken into consideration evidence from the project.