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SMBG and glycaemic control in T2D – results from a randomised trial

This study set out to critically examine the orthodoxy that it is important for people with type 2 diabetes who are taking insulin to perform regular self-monitoring of blood glucose (SMBG), as recommended by NICE guideline CG87. Over a 12-month period, the investigators separately explored two aspects of this: the performing of once-weekly SMBG; and access of the user to the HbA1c results. Neither once-weekly SMBG testing nor access to the HbA1c results improved glycaemic control in people with type 2 diabetes receiving conventional insulin treatment.

by Colin Kenny, GP, Dromore

This randomised trial enrolled 300 people with type 2 diabetes who were being treated with a conventional insulin regimen (basal or premixed insulin with or without additional oral glucose-lowering agents). In the 2×2 factorially designed experiment, once-weekly four-point glucose profiles were compared with no self-monitoring of blood glucose (SMBG), while the provision of HbA1c results to study participants was compared with non-disclosure of results.

Patient characteristics were balanced across groups and there was a low incidence of hypoglycaemia. Regular SMBG did not improve HbA1c levels, and the disclosure of HbA1c results had no significant influence on outcomes.

A single trial of this type does not justify withholding or limiting testing strips, although it suggests that individuals with type 2 diabetes, even when treated with insulin, may derive little benefit from SMBG with regard to potentially helping them to improve their blood glucose control or reducing hypoglycaemia.

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