Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Cardiovascular risk outweighs glucose self-monitoring
- Andrew M Solomon (23 July 2007)
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The value of blood glucose self monitoring in type 2 diabetes is limited
- Gerard Keele (31 July 2007)
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Monitoring in type 2 diabetes can have other implications
- Suhayr T Xavier, Yvonne Young (2 August 2007)
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Andrew M Solomon, SpR in Diabetes and Endocrinology North Thames SpR Rotation (NW3 2QG)
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It was refreshing to read the article written by Farmer et al. which answered a question that many of us feel needed to be addressed in a quantifiable and convincing manner. Type 2 diabetes (and certainly impaired fasting glycaemia/glucose tolerance) often exists for years before diagnosis, yet glycaemia often seems such a pressing matter in the clinic. Surely this should be seen by both clinicians and patients as a disease of cardiovascular risk more than glycaemia, at least in the clinical time available before the use of insulin. In effect, it's a race to reduce risk. Intermittent HbA1c monitoring is surely sufficient for the majority. The paper should encourage all clinicians to refocus their targets in Type 2 diabetes. The findings of their paper are saluted. a.solomon@medsch.ucl.ac.uk Competing interests: None declared |
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Gerard Keele, Retired General Practitioner 5, The Willows, Brent Knoll, Somerset, TA9 4EJ
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Since my type 2 diabetes was diagnosed in 1999 at the age of 56 I have been using blood glucose self monitoring (BGSM). My experience supports your editorial which questions the value of using BGSM at diagnosis and encourages patients to have the confidence to discontinue it if they consider it of no benefit. In my view BGSM has only a limited role in management of type 2 diabetes. It has no role to play in managing patients who are not on a sulphonylurea, and should not be used in patients who continue to show glycosuria on routine urine testing. Given a normal renal threshold, any glycosuria is an indication that control is suboptimal, and evidence from BGSM will not aid clinical decisions unless control is so poor that insulin is being considered. However, patients who are free from sugar on urine testing may benefit from the closer monitoring that BGSM makes possible, and their control can be improved further. Because of my interest in electronic records I set up a home database to record my blood sugars. This has enabled me to calculate means of values at specific times of the day and to present my records in a format that is easy to read at review. Monitoring trends is relatively simple and I can relate these trends to HbA1c values. I have also been able to conduct simple trials of the effect of exercise on postprandial peaks in blood sugar. After five years of reasonably intensive monitoring I felt that I had evidence enough to restrict monitoring to weekly fasting records. I doubt that I will give up BGSM entirely because these tests do provide me with reassurance and an early warning that my control is not as good as it should be. The structured use of BGSM provides a powerful tool to learn about diabetic control, and specific learning objectives for the patients could easily be incorporated into management guidelines. These objectives would also provide a helpful framework for discussing diabetic control at review appointments. Gerard Keele Retired general practitioner, 5 The Willows, Brent Knoll, Somerset, TA9 4EK ged.keele@btopenworld.com Competing interests: None declared |
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Suhayr T Xavier, Specialist Registrar in Public Health Kingston Primary Care Trust, 22 Hollyfield Road, Surrey KT5 9AL, Yvonne Young
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We read the recent article and editorial about self monitoring of blood glucose in type 2 diabetes with interest (Self monitoring in type 2 diabetes: does it work?). The papers raised points pertinent to a recent hepatitis B outbreak in a care home in which elderly residents of the home were found to have contracted hepatitis B via blood glucose monitoring. Investigations of the outbreak, led by the local health protection unit, revealed that 100% of diabetic residents (and no non-diabetics), on a unit in the home, were infected with hepatitis B from a chronic carrier. The most likely mode of transmission was via blood glucose monitoring devices. It was found that the lancing devices used in the home for blood glucose monitoring were not appropriate for use in a multi-patient setting and were intended for patient self use only. These were immediately discarded and single use disposable lancets were introduced. All of the cases were stable non-insulin dependent diabetics and the issue surrounding the frequency of their blood glucose testing was raised at the time as this varied from twice daily to twice weekly. The recommendation was made that all stable diabetic patients should be reviewed by their clinicians and that the home should be offered guidance on the most appropriate testing regimen. This had the dual aim of both reducing unnecessary excessive testing and lessening the risk of any further potential exposure to blood borne viruses. Clearly there are important risks involved in near patient testing techniques and anything that minimises the exposure to these potential risks is to be welcomed. In this instance the change to single use disposable lancing devices was a key control measure but adapting the frequency of blood glucose monitoring, particularly if it is offering no clear benefit to diabetes control, should also be carefully considered. Competing interests: None declared |
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