Sunday, September 27, 2009

HTA report: Research assesses the use of glucose monitoring for type 1 and type 2 diabetes

The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme has published two new studies focusing on self-monitoring of blood glucose (SMBG) levels in the management of both type 1 and type 2 diabetes.

The first study, (the Diabetes Glycaemic Education and Monitoring [DiGEM] tested whether self-monitoring of blood glucose alone, or with training in incorporating the findings into self-care, compared with standardised usual care improved glycaemic control in non-insulin treated patients with type 2 diabetes. The DiGEM trial has previously been published in the BMJ (see previous NeLM news report link below).  The trial involved 453 participants recruited from 48 general practises in Oxford and South Yorkshire and found that the routine use of SMBG, with or without additional training, was associated with higher costs and lower quality of life in patients with well controlled non-insulin treated type 2 diabetes.

The second study assessed the effectiveness and acceptability to patients of two minimally invasive continuous glucose monitoring devices (Glucowatch® and the MiniMed® Continuous Glucose Monitoring System) to help improve diabetes control. The study randomised 404 participants into four groups: group one wore the Glucowatch a minimum of four times per month and a maximum of four times per week for the first three months; group two had the MiniMed Continuous Glucose Monitoring System fitted three times over the first three months of the study; group three received standard treatment with three nurse feedback sessions during the first three months; and group four received standard treatment only.

The results found no significant difference between any of the groups and indicated no advantage in having the additional information provided by a continuous glucose monitoring device. The study found that continuous glucose monitors do not lead to improved clinical outcomes in individuals with poorly controlled, insulin-requiring diabetes.

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