What did the media say?
The media reported that encouraging type 2 diabetes patients to monitor their own blood sugar levels may not improve care and is a waste of NHS resources.
What did the research show?
The stories were based on two studies published online by the BMJ. One, the DiGEM trial, carried out by Oxford University researchers, assessed the cost-effectiveness of HbA1C self-monitoring.
The study involved 453 diabetes patients in primary care settings. Researchers compared usual care with HbA1C self-monitoring and monitoring plus training in self-interpretation of the results. Quality of life scores and financial costs were measured 12 months before the trial and 12 months afterwards.
They calculated the average annual cost of monitoring alone was £92 more per patient than usual care while monitoring plus interpretation cost £84 more. Additionally, a slightly negative impact on life quality scores was seen with the two interventions – probably due to increased levels of anxiety and depression, the authors said.
The second paper, on the findings of the ESMON study, was written by researchers from Ulster University and looked at hospital diabetes clinics. The one-year study compared self-monitoring versus no monitoring in 184 patients aged 70 or older with newly-diagnosed type 2 diabetes.
The researchers identified no significant differences between the groups in HbA1C control, body mass index, use or anti-diabetes drugs or hypoglycaemic events. However, self-monitoring was linked with a 6% higher depression score, the authors said.
What did the researchers say?
The authors of the DiGEM research said: ‘This study provides no convincing evidence for routinely recommending self-monitoring to patients with non-insulin treated type 2 diabetes.’
‘Our results suggest it is not associated with any improvement in glycaemic control in such patients and might be associated with reduced wellbeing,’ added the authors of the ESMON study.
What does this mean for nursing practice?
Libby Dowling, care advisor at Diabetes UK, said: ‘In general, those who are self-monitoring are likely to be on more medication, have had type 2 diabetes for longer and may already have serious complications. In addition, many people with diabetes are not sufficiently educated about self-monitoring.
‘Any or all of these factors could lead to feelings of anxiety and depression, but it is unlikely to be the actual self-monitoring alone that is the cause of them,’ she said.
‘Self-monitoring must be accompanied by a structured education programme to teach people how and when to test, interpret results and take appropriate action,’ she added.
BMJ First Online (2008)