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Is Self-Monitoring of Blood Glucose Appropriate for All Type 2 Diabetic Patients? The Fremantle Diabetes Study

Response to Davis et al.

¹ German Diabetes Center at the Heinrich-Heine University, Düsseldorf, Germany
² Institute of Biometry, Medical University of Hannover, Hannover, Germany
³ Profil Institute for Metabolic Research, Neuss, Germany
⁴ Institute for Medical Informatics and Biostatistics, Basel, Switzerland

Address correspondence to Hubert Kolb, German Diabetes Center, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany. E-mail: hubert.kolb{at}uni-duesseldorf.de

The analysis of self-monitoring of blood glucose (SMBG) in the community-based observational Fremantle Diabetes Study (1) becomes even more interesting when combined with three other studies of SMBG in type 2 diabetes: the Italian Qualità ed Esito in Diabetologia (QuED) Project (2), analyses of the Kaiser Permanente Northern California Medical Care Program (3), and the German ROSSO Study (4).

All four studies concur that patients using SMBG are younger at diagnosis by 3–4 years (1,2,4). Patients present with higher A1C (mean +0.9%) (4). Even during continuous use of SMBG, mean A1C levels are slightly higher (difference 0.2–0.3%) (2–4) or slightly lower (–0.3%) (1) than in patients not using SMBG (mean of all four studies +0.2–0.3%).

Where, then, is the assumed beneficial impact of SMBG on blood glucose control? Though one cannot see it in cross-sectional analyses, it is evident in longitudinal studies. In the ROSSO Study, mean A1C is different at diagnosis between later SMBG users and permanent nonusers by 0.9%. In later years, the initial large difference almost disappeared; i.e., metabolic control improved significantly more in patients using SMBG than in nonusers (4). Similarly, in the Kaiser Permanente cohort, there was an improvement of A1C by 0.6% after initiation of SMBG, whereas A1C deteriorated by 0.2% in nonusers. These opposing changes were also observed after adjustments for change of type of antidiabetic medication or other potential confounders (3).

This concordance of observational studies on three different continents is remarkable. In the real world, SMBG appears to be preferentially used by younger patients who exhibit worse than average metabolic control, and the initiation of SMBG is followed by improved metabolic control.

References

1. Davis WA, Bruce DG, Davis TME: Is self-monitoring of blood glucose appropriate for all type 2 diabetic patients? The Fremantle Diabetes Study. Diabetes Care 29:1764–1770, 2006[Abstract/Free Full Text]
   
2. Franciosi M, Pellegrini F, De Berardis G, Belfiglio M, Di Nardo B, Greenfield S, Kaplan SH, Rossi MCE, Sacco M, Tognoni G, Valentini M, Nicolucci A, the QuED Study Group: Self-monitoring of blood glucose in non-insulin-treated diabetic patients: a longitudinal evaluation of its impact on metabolic control. Diabet Med 22:900–906, 2005[Medline]
   
3. Karter AJ, Chan J, Parker MM, Moffet HH, Spence MM, Chan J, Ettner SL, Selby JV: Longitudinal study of new and prevalent use of self-monitoring of blood glucose. Diabetes Care 29:1757–1763, 2006[Abstract/Free Full Text]
   
4. Martin S, Schneider B, Heinemann L, Lodwig V, Kurth H-J, Kolb H, Scherbaum WA, the ROSSO Study Group: Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological study. Diabetologia 49:271–278, 2006[Medline]
   

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				W. A. Davis, D. G. Bruce, and T. M.E. Davis Is Self-Monitoring of Blood Glucose Appropriate for All Type 2 Diabetic Patients? The Fremantle Diabetes Study: Response to Kolb et al. Diabetes Care, January 1, 2007; 30(1): 184 - 185. [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 Kolb, H. Articles by Martin, S. Search for Related Content PubMed PubMed Citation Articles by Kolb, H. Articles by Martin, S. Social Bookmarking                What's this?