Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About CFP Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About CFP Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
Research ArticlePractice

Routine self-monitoring of blood glucose

G. Michael Allan, Christina Korownyk and Noah Ivers
Canadian Family Physician September 2011, 57 (9) 1015;
G. Michael Allan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Christina Korownyk
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Noah Ivers
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

Clinical question

What are the pros and cons of routine self-monitoring of blood glucose (SMBG) for patients with type 2 diabetes (T2D) who do not use insulin?

Evidence

  • Recent meta-analyses1–3 examined routine SMBG in patients with T2D who do not use insulin.

    • -Largest analysis had 26 studies with 5373 patients.1

    • -With SMBG, HbA1c levels improved 0.21% to 0.31%.1–3

  • Only 3 of the trials that compared SMBG with no SMBG were of high quality.1

    • -A 6-month trial (DINAMIC study)4 found

      • —SMBG improved HbA1c by 0.25% (P = .0097) and

      • —no difference in weight, fasting glucose, or gliclazide dose.

    • -Two 12-month trials (DiGEM5 and ESMON6) found no difference in HbA1c levels, drug initiation, or weight.

  • Self-monitoring of blood glucose has not been shown to attain a minimum clinically important difference in HbA1c (≥ 0.5%)7 in any meta-analysis or high-quality trial.

Context

  • Important harms of routine SMBG include worsening of depression scores,6,8 reduced quality of life,8,9 and poor value for dollar9,10; in patients with T2D who do not use insulin, there is also little to no clinical value.

    • -This evidence does not apply to patients with T2D who use insulin, patients with T1D, or pregnant patients with gestational diabetes.

  • Reasons for nonroutine blood glucose testing include

    • -having symptoms of hypoglycemia or feeling unwell, as these symptoms often do not correlate well with actual blood sugar levels,11

    • -seeing the effects of changes to medication, diet, or lifestyle behaviour on sugar status, and

    • -nonroutine circumstances (eg, driving).

Bottom line

Routine SMBG in patients with T2D who do not use insulin has no clinical benefits, is not cost-effective, and reduces the quality of life.

Implementation

The burden of SMBG should be minimized to the amount necessary to inform decision making. For patients with T2D who use only oral medications, routine SMBG rarely leads to changes in management, so discouraging this might benefit patients. Reactive SMBG (eg, in response to symptoms or specific circumstances) remains appropriate. Patients taking medications that can cause hypoglycemia require education on recognizing and managing these symptoms. The National Diabetes Information Clearinghouse website has handouts available (http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/index.aspx).

Notes

Tools for Practice articles in Canadian Family Physician are adapted from articles published twice monthly on the Alberta College of Family Physicians (ACFP) website, summarizing medical evidence with a focus on topical issues and practice-modifying information. The ACFP summaries and the series in Canadian Family Physician are coordinated by Dr G. Michael Allan, and the summaries are co-authored by at least 1 practising family physician. Feedback is welcome and can be sent to toolsforpractice{at}cfpc.ca. Archived articles are available on the ACFP website: www.acfp.ca.

Footnotes

  • This article is eligible for Mainpro-M1 credits. To earn credits, go to www.cfp.ca and click on the Mainpro link.

  • The opinions expressed in Tools for Practice articles are those of the authors and do not necessarily mirror the perspective and policy of the Alberta College of Family Physicians.

  • Copyright© the College of Family Physicians of Canada

References

  1. ↵
    1. Clar C,
    2. Barnard K,
    3. Cummins E,
    4. Royle P,
    5. Waugh N,
    6. Aberdeen Health Technology Assessment Group
    . Self-monitoring of blood glucose in type 2 diabetes: systematic review. Health Technol Assess 2010;14(12):1-140.
    OpenUrlPubMed
    1. Allemann S,
    2. Houriet C,
    3. Diem P,
    4. Stettler C
    . Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis. Curr Med Res Opin 2009;25(12):2903-13.
    OpenUrlCrossRefPubMed
  2. ↵
    1. McIntosh B,
    2. Yu C,
    3. Lal A,
    4. Chelak K,
    5. Cameron C,
    6. Singh SR,
    7. et al
    . Efficacy of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin: a systematic review and meta-analysis. Open Med 2010;4(2):e102-13. Epub 2010 May 18.
    OpenUrlPubMed
  3. ↵
    1. Barnett AH,
    2. Krentz AJ,
    3. Strojek K,
    4. Sieradzki J,
    5. Azizi F,
    6. Embong M,
    7. et al
    . The efficacy of self-monitoring of blood glucose in the management of patients with type 2 diabetes treated with a gliclazide modified release-based regime. A multicentre, randomized, parallel-group, 6-month evaluation (DINAMIC 1 study). Diabetes Obes Metab 2008;10(12):1293-47. Epub 2008 May 20.
    OpenUrl
  4. ↵
    1. Farmer A,
    2. Wade A,
    3. Goyder E,
    4. Yudkin P,
    5. French D,
    6. Craven A,
    7. et al
    . Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial. BMJ 2007;335(7611):132. Epub 2007 Jun 25.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. O’Kane MJ,
    2. Bunting B,
    3. Copeland M,
    4. Coates VE,
    5. ESMON study group
    . Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial. BMJ 2008;336(7654):1174-7. Epub 2008 Apr 17.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. National Institute for Health and Clinical Excellence
    . NICE short clinical guideline 87. Type 2 diabetes: newer agents for blood glucose control in type 2 diabetes. London, UK: NICE; 2009. Available from: www.nice.org.uk/nicemedia/pdf/CG87ShortGuideline.pdf. Accessed 2011 Jun 16.
  7. ↵
    1. Franciosi M,
    2. Pellegrini F,
    3. De Berardis G,
    4. Belfiglio M,
    5. Cavaliere D,
    6. Di Nardo B,
    7. et al
    . The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies. Diabetes Care 2001;24(11):1870-7.
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Simon J,
    2. Gray A,
    3. Clarke P,
    4. Wade A,
    5. Neil A,
    6. Farmer A
    . Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial. BMJ 2008;336(7654):1177-80. Epub 2008 Apr 17.
    OpenUrlAbstract/FREE Full Text
  9. ↵
    1. Cameron C,
    2. Coyle D,
    3. Ur E,
    4. Klarenbach S
    . Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin. CMAJ 2010;182(1):28-34. Epub 2009 Dec 21.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Pramming S,
    2. Thorsteinsson B,
    3. Bendtson I,
    4. Binder C
    . The relationship between symptomatic and biochemical hypoglycaemia in insulin-dependent diabetic patients. J Intern Med 1990;228(6):641-6.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Canadian Family Physician: 57 (9)
Canadian Family Physician
Vol. 57, Issue 9
1 Sep 2011
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Routine self-monitoring of blood glucose
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
Citation Tools
Routine self-monitoring of blood glucose
G. Michael Allan, Christina Korownyk, Noah Ivers
Canadian Family Physician Sep 2011, 57 (9) 1015;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Routine self-monitoring of blood glucose
G. Michael Allan, Christina Korownyk, Noah Ivers
Canadian Family Physician Sep 2011, 57 (9) 1015;
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Clinical question
    • Evidence
    • Context
    • Bottom line
    • Implementation
    • Notes
    • Footnotes
    • References
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • No related articles found.
  • Scopus
  • PubMed
  • Google Scholar

Cited By...

  • Top studies relevant to primary care practice
  • Scopus (1)
  • Google Scholar

More in this TOC Section

Practice

  • Measuring what really matters
  • Topical treatments for rosacea
  • Palliative care in patients with severe mental illness
Show more Practice

Tools for Practice

  • Topical treatments for rosacea
  • Incidence of iatrogenic opioid use disorder
  • Biosimilars versus biologics for inflammatory conditions
Show more Tools for Practice

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2019 by The College of Family Physicians of Canada

Powered by HighWire