Diabetes: Study Looks at Self-Monitoring and Health Outcomes for Type 2 Clients

Research based on a year-long study and reported at the American Diabetes Association's 67th Annual Scientific Sessions last June calls into question whether frequent glucose self-monitoring by type 2 diabetes patients who do not use insulin leads to better control of their sugar levels.

"No self-monitoring was compared to two different intensities of self-monitoring, and no clinically significant different reductions were seen in results on A1C tests," reported Andrew J. Farmer, a principal investigator on the Diabetes Glycemic Education and Monitoring (DiGEM) study.

The DiGEM team wanted better answers than have so far been available to the question of whether self-monitoring actually leads to better outcomes for type 2 diabetics. While physicians and others involved in diabetes care acknowledge self-monitoring can be expensive and a hassle, they assumed that patients could best manage their sugar levels if they continuously kept track of them during the day or week.

Previous research that tested this assumption was inconclusive because subjects' glycemic control (or lack of it) could have been explained by multiple factors, self monitoring being only one.

The research followed three groups of type 2 diabetics for a year. Members of one group didn't self-monitor, but followed generally accepted guidelines about diet and exercise, and they checked in with their doctors every three months. The other two groups self-monitored, one more intensively than the other.

The researchers found virtually no difference among the groups in how well blood glucose was managed. "At baseline, mean A1C glycated hemoglobin, which measures how well patients control their glucose during the previous two to three months across the groups was similar at 7.5 percent. At 12 months, the results were again similar. The mean A1C difference between the control and less-intensive self monitoring group was -0.14 percent, and between the control and more-intensive self-monitoring group -0.17 percent. The differences between the three groups were not statistically significant (P=0.12)."

The researchers wrote that for self-monitoring to have been vindicated, it would have had to make a difference of at least -0.5 percent. "We powered the study to be able to see a difference that large if it existed," said Farmer, "but we did not get it."

This article originally appeared in the July 2007 issue of HME Business.

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