BMJ  2007;335:271 (11 August), doi:10.1136/bmj.39297.457014.1F

Letters

Self monitoring in diabetes

Useful in which patients?

The first 150 words of the full text of this article appear below.

The conclusion of the randomised trial reported by Farmer et al¹ is in line with a recent systematic review of randomised trials (1000 patients, three trials) and observational studies (60 000 patients, 13 studies),² which shows that only when the average starting HbA_1c is above 8% do studies consistently show benefit of self monitoring.

The inference that self monitoring may be beneficial where control is poor is just common sense. That it is difficult to show benefit when control is already pretty good is also common sense—there is no sensitivity to show a difference even if there were one.

A different way of reporting results of trials like this would be interesting. Our interest is not in the average patient, since few patients are average: what we require is to know the number of patients who showed improvement (however defined, or perhaps at several levels of HbA_1c) versus the . . . [Full text of this article]

Pain Research, Nuffield Department of Anaesthetics, University of Oxford, The Churchill, Oxford OX3 7LJ

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Relevant Article

Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial

Andrew Farmer, Alisha Wade, Elizabeth Goyder, Patricia Yudkin, David French, Anthea Craven, Rury Holman, Ann-Louise Kinmonth, and Andrew Neil
BMJ 2007 335: 132. [Abstract] [Full Text] [PDF]