BMJ, doi: 10.1136/bmj.39534.571644.BE, (Published 17 April 2008)

Research

Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial

Maurice J O’Kane, consultant1, Brendan Bunting, professor2, Margaret Copeland, trial manager3, Vivien E Coates, professor3, on behalf of the ESMON study group

1 Department of Clinical Chemistry, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, Northern Ireland, 2 Psychology Research Institute, University of Ulster, Londonderry, Northern Ireland, 3 Institute of Nursing Research, University of Ulster, Coleraine, Northern Ireland

Correspondence to: M J O’Kane Maurice.OKane{at}westerntrust.hscni.net

Objectives To assess the effect of self monitoring of blood glucose concentrations on glycaemic control and psychological indices in patients with newly diagnosed type 2 diabetes mellitus.

Design Prospective randomised controlled trial of self monitoring versus no monitoring (control).

Setting Hospital diabetes clinics.

Participants 184 (111 men) people aged <70 with newly diagnosed type 2 diabetes referred to the participating diabetes clinics. Major exclusion criteria were secondary diabetes, insulin treatment, previous self monitoring of blood glucose.

Interventions Participants were randomised to self monitoring or no monitoring (control) groups for one year with follow-up at three monthly intervals. Both groups underwent an identical structured core education programme. The self monitoring group received additional education on monitoring.

Main outcome measures Between group differences in HbA1c, psychological indices, use of oral hypoglycaemic drugs, body mass index (BMI), and reported hypoglycaemia rates.

Results 96 patients (55 men) were randomised to monitoring and 88 (56 men) to control. There were no baseline differences in mean (SD) age (57.7 (11.0) in monitoring group v 60.9 (11.5) in control group) or HbA1c (8.8 (2.1)% v 8.6 (2.3)%, respectively). Those in the monitoring group had a higher baseline BMI (34 (7) v 32 (6.2)). There were no significant differences between groups at any time point (12 months values given) in HbA1c (6.9 (0.8)% v 6.9 (1.2)%, P=0.69; 95% confidence interval for difference –0.25% to 0.38%), BMI (33.1 (6.4) v 31.8 (6.0); adjusted for baseline BMI, P=0.32), use of oral hypoglycaemic drugs, or reported incidence of hypoglycaemia. Monitoring was associated with a 6% higher score on the depression subscale of the well-being questionnaire (P=0.01).

Conclusions In patients with newly diagnosed type 2 diabetes self monitoring of blood glucose concentration has no effect on glycaemic control but is associated with higher scores on a depression subscale.

Trial registration ISRCTN 49814766.


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Why patients who self monitor glucose might be more depressed
Lucy M Candib
BMJ 2008 336: 1263-1264. [Extract] [Full Text] [PDF]

Self monitoring of blood glucose in type 2 diabetes
Martin Gulliford
BMJ 2008 336: 1139-1140. [Extract] [Full Text] [PDF]

Self monitoring of blood glucose in type 2 diabetes: longitudinal qualitative study of patients' perspectives
Elizabeth Peel, Margaret Douglas, and Julia Lawton
BMJ 2007 335: 493. [Abstract] [Full Text] [PDF]

Self monitoring of blood glucose in type 2 diabetes
Simon R Heller
BMJ 2007 335: 105-106. [Extract] [Full Text] [PDF]

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]

Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study
Irene M Stratton, Amanda I Adler, H Andrew W Neil, David R Matthews, Susan E Manley, Carole A Cull, David Hadden, Robert C Turner, and Rury R Holman
BMJ 2000 321: 405-412. [Abstract] [Full Text] [PDF]

Comparison of blood or urine testing by patients with newly diagnosed non-insulin dependent diabetes: patient survey after randomised crossover trial
Pat Miles, Joan Everett, June Murphy, and David Kerr
BMJ 1997 315: 348-349. [Extract] [Full Text]

This article has been cited by other articles:

  • Boutati, E. I., Raptis, S. A. (2009). Self-Monitoring of Blood Glucose as Part of the Integral Care of Type 2 Diabetes. Diabetes Care 32: S205-S210 [Abstract] [Full text]  
  • Bossuyt, P. M. M., McCaffery, K. (2009). Additional Patient Outcomes and Pathways in Evaluations of Testing. Med Decis Making 29: E30-E38 [Abstract]  
  • Florkowski, C., Budgen, C., Kendall, D., Lunt, H., Moore, M P. (2009). Comparison of blood glucose meters in a New Zealand diabetes centre. Ann Clin Biochem 46: 302-305 [Abstract] [Full text]  
  • O'Kane, M. J, Pickup, J. (2009). Self-monitoring of blood glucose in diabetes: is it worth it?. Ann Clin Biochem 46: 273-282 [Abstract] [Full text]  
  • Montori, V. M., Fernandez-Balsells, M. (2009). Glycemic Control in Type 2 Diabetes: Time for an Evidence-Based About-Face?. ANN INTERN MED 150: 803-808 [Abstract] [Full text]  
  • Haynes, R B., Haynes, G. A (2009). What does it take to put an ugly fact through the heart of a beautiful hypothesis?. Evid. Based Med. 14: 68-69 [Full text]  
  • Istepanian, R. S., Zitouni, K., Harry, D., Moutosammy, N., Sungoor, A., Tang, B., Earle, K. A (2009). Evaluation of a mobile phone telemonitoring system for glycaemic control in patients with diabetes. J Telemed Telecare 15: 125-128 [Abstract] [Full text]  
  • Pignone, M. (2009). Value of Self-Monitoring of Blood Glucose in Non-Insulin-Using Patients With Type 2 Diabetes. Clin. Diabetes 27: 17-18 [Full text]  
  • American Diabetes Association, (2009). Standards of Medical Care in Diabetes--2009. Diabetes Care 32: S13-S61 [Full text]  
  • Bhattacharyya, O. K. MD PhD, Shah, B. R. MD PhD, Booth, G. L. MD MSc (2008). Management of cardiovascular disease in patients with diabetes: the 2008 Canadian Diabetes Association guidelines. CMAJ 179: 920-926 [Full text]  
  • Candib, L. M (2008). Why patients who self monitor glucose might be more depressed. BMJ 336: 1263-1264 [Full text]  
  • Gulliford, M. (2008). Self monitoring of blood glucose in type 2 diabetes. BMJ 336: 1139-1140 [Full text]  

Rapid Responses:

Read all Rapid Responses

Mean weekly glycemia: a SMBG-derived method for near-real-time evaluation of glycemic control and of adequacy of treatment strategy
AUGUSTO PIMAZONI, MD
bmj.com, 20 Apr 2008 [Full text]
why self-monitoring patients might score higher in depression
Lucy M. Candib
bmj.com, 20 Apr 2008 [Full text]
Merely proves there is no point in home monitoring if you ignore the results
Ben L Balzer
bmj.com, 26 Apr 2008 [Full text]
Ignoring the obvious
Patti D Evans
bmj.com, 24 Aug 2008 [Full text]
Compliance and Contamination
James A Campbell
bmj.com, 16 Nov 2008 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ