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Am Fam Physician. 2017;96(12):online

Clinical Question

Does home monitoring of blood glucose levels improve glycemic control or quality of life in patients with type 2 diabetes mellitus who are not using insulin?

Bottom Line

Home glucose monitoring of patients in primary care does not improve A1C scores or quality of life over one year in patients who are not taking insulin. Patients did not feel more empowered or satisfied as a result of home monitoring, nor did they have fewer hypoglycemic episodes, and their physicians did not seem to respond to the home glucose levels to any beneficial effect. (Level of Evidence = 1b)

Synopsis

These researchers identified adults (average age = 61 years) with type 2 diabetes not treated with insulin and who had A1C levels between 6.5% and 9.5%. Most of the patients (75%) monitored their blood glucose levels at home before the study but had not been treated by an endocrinologist. The 450 patients (who had type 2 diabetes for an average of eight years) were randomly assigned, using concealed allocation, to one of three arms: (1) no home glucose monitoring; (2) standard once-daily monitoring; and (3) enhanced once-daily monitoring, consisting of glucose values immediately reported to the patient plus automated, tailored messaging delivered via the meter. The patients' physicians were given the home glucose monitoring results but were not asked to follow a specific protocol to respond to them. After both six months and one year, there were no differences, on average, among the groups in A1C levels, hospitalizations, episodes of severe hypoglycemia, or quality-of-life scores. Similarly, there was no difference among groups in treatment satisfaction or feelings of empowerment.

Study design: Randomized controlled trial (nonblinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (any)

Reference: YoungLABuseJBWeaverMAet alMonitor Trial GroupGlucose self-monitoring in non-insulin-treated patients with type 2 diabetes in primary care settings: a randomized trial. JAMA Intern Med2017;177(7):920–929.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

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