Level 3: Lacking direct evidence
The Diabetes Glycaemic Education and Monitoring Trial evaluated the effect of glucose self-monitoring on glycemic control in 453 patients (mean age 65.7 years) with reasonably controlled (mean hemoglobin A1c [HbA1c] 7.5%) noninsulin-treated type 2 diabetes for median three years (BMJ. 2007;335:132; full-text available online free of charge at: www.bmj.com/cgi/content. Accessed January 10, 2008). The patients were randomized to one of three groups: usual care with HbA1c measured by health-care professionals every three months vs. blood glucose meter with instructions to contact a physician for interpretation of the results vs. blood glucose meter with training in self-interpretation and application of results to diet, activity, and drug adherence.
At 12 months, there were no significant differences between groups in changes in HbA1c (0 in control group without self-monitoring of blood glucose vs. -0.14% with self-monitoring and physician interpretation vs. -0.17% with self-monitoring and self-management). There were no significant differences between groups in BP, weight, or BMI. The self-management group had significantly greater reductions in total cholesterol level (-0.23 mmol/L [-8.9 mg/dL] vs. control group) and total cholesterol-to-HDL ratio. Self-monitoring groups had more patients with symptomatic hypoglycemic episodes than the control group (22%-28% vs. 9%, P<.001, NNH 5-7).