Self-monitoring of blood glucose in diabetes: is it worth it?

This version was published on 1 July 2009

Ann Clin Biochem 2009;46:273-282
doi:10.1258/acb.2009.009011
© 2009 Association for Clinical Biochemistry

 

 

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Review Article


Maurice J O’Kane1 and
John Pickup2


1 Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry BT 47 6SB, N Ireland;
2 King’s College London School of Medicine, Guy’s Hospital, London SE1 9RT, UK


Corresponding author: Dr Maurice J O’Kane. Email: Maurice.OKane{at}westerntrust.hscni.net

Self-monitoring of blood glucose (SMBG) is advocated as a valuableaid in the management of diabetes. The volume and cost of monitoringcontinues to increase. SMBG has a number of theoretical advantages/disadvantageswhich might impact on treatment, outcome and wellbeing. Investigatingand quantifying the effect of self-monitoring in a conditionwhere self-management plays a central role poses major methodologicaldifficulties because of the need to minimize confounding factors.Despite the absence of definitive evidence, some situationswhere monitoring is generally accepted to be beneficial includepatients on insulin, during pregnancy, in patients with hypoglycaemiaunawareness and while driving. An area of controversy is therole of monitoring in non-insulin-requiring type-2 diabeteswhere observational and controlled studies give conflictingresults. The available evidence does not support the generaluse of monitoring by all patients with type-2 diabetes, althoughfurther research is needed to identify specific subgroups ofpatients or specific situations where monitoring might be useful.The best use of SMBG in patients with type-2 diabetes mightbe for those receiving insulin and those on sulphonylurea drugs.The impact of monitoring on patient wellbeing must also be considered,with some studies suggesting adverse psychological effects.Given the large increase in the prevalence of type-2 diabetes,it will be important to define the role of SMBG so that resourcescan be used appropriately. Presently, the widespread use ofSMBG (particularly in type-2 diabetes patients) is a good exampleof self-monitoring that was adopted in advance of robust evidenceof its clinical efficacy.


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