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Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes Who Are Not Using Insulin

Response to Welschen et al

¹ Department of Internal Medicine, Isala Clinics, Zwolle, the Netherlands
² Department of General Practice, University of Groningen, Groningen, the Netherlands.

Address correspondence to Nanne Kleefstra, MD, Langerhans Foundation, Department of Internal Medicine, Isala Clinics, Weezenlanden Location, P.O. Box 10500, 8000 GM Zwolle, Netherlands. E-mail: kleefstra{at}langerhans.com

Response to Welschen et al.

We read the article by Welschen et al. (1) in Diabetes Care with interest. It systematically reviewed the effect of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes who are not using insulin. This review is important and provides an answer to the extensive debate about this interesting topic.

The same authors published a systematic review on the same topic in April 2005 in the Cochrane Library (2). The same articles were included in both reviews. The authors performed a meta-analysis in the review published in Diabetes Care and concluded that there is a 0.39% decrease in HbA_1c (A1C) when allowing SMBG. This effect should be interpreted with caution because of the methodological quality of the trials as addressed in the "Methodological issues" section of the review. Also, in one of the two studies in which a statistically significant decrease of A1C was found, only the SMBG group received education (3). A meta-analysis from Ellis et al. (4) concluded that on average, the influence of education itself on A1C is 0.32%.

However, in the Cochrane Library review, the authors write "Because of differences in baseline data of the patients and type of interventions between the studies, it was not possible to perform either a meta-analysis and/or subgroup or sensitivity analyses." In this review, they conclude "SMBG might be effective in improving glycemic control in patients with type 2 diabetes who are not using insulin."

Within a few months, the authors reach different conclusions regarding methodology and supposed effects based on the same set of available information. Which is true: a clinically relevant reduction in A1C or a conclusion that SMBG might be effective in improving glycemic control in patients with type 2 diabetes who are not using insulin?

References

1. Welschen LM, Bloemendal E, Nijpels G, Dekker JM, Heine RJ, Stalman WA, Bouter LM: Self-monitoring of blood glucose in patients with type 2 diabetes who are not using insulin: a systematic review. Diabetes Care 28:1510–1517, 2005[Free Full Text]
   
2. Welschen LM, Bloemendal E, Nijpels G, Dekker JM, Heine RJ, Stalman WA, Bouter LM: Self-monitoring of blood glucose in patients with type 2 diabetes who are not using insulin. Cochrane Database Syst Rev 2:CD005060, 2005
   
3. Schwedes U, Siebolds M, Mertes G; SMBG Study Group: Meal-related structured self-monitoring of blood glucose: effect on diabetes control in non-insulin-treated type 2 diabetic patients. Diabetes Care 25:1928–1932, 2002[Abstract/Free Full Text]
   
4. Ellis SE, Speroff T, Dittus RS, Brown A, Pichert JW, Elasy TA: Diabetes patient education: a meta-analysis and meta-regression. Patient Educ Couns 52:97–105, 2004[Medline]
   

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This article has been cited by other articles:

				M. B. Davidson Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes Who Are Not Using Insulin: Response to Welschen et al. and Kleefstra et al Diabetes Care, October 1, 2005; 28(10): 2597 - 2597. [Full Text] [PDF]

				L. M.C. Welschen, E. Bloemendal, G. Nijpels, J. M. Dekker, R. J. Heine, W. A.B. Stalman, and L. M. Bouter Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes Who Are Not Using Insulin: Response to Kleefstra et al. and Davidson Diabetes Care, October 1, 2005; 28(10): 2597a - 2598a. [Full Text] [PDF]

This Article Extract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kleefstra, N. Articles by Bilo, H. J.G. Search for Related Content PubMed PubMed Citation Articles by Kleefstra, N. Articles by Bilo, H. J.G. Social Bookmarking                What's this?