In the accompanying papers, O’Kane and colleagues report a randomised controlled trial of blood glucose self monitoring in people with newly diagnosed diabetes (ESMON trial) and Simon and colleagues report a cost effectiveness analysis that ran alongside the previously published blood glucose self monitoring in type 2 diabetes (DiGEM) trial.1 2 3

The question of whether people with type 2 diabetes who do not use insulin should monitor their own blood glucose has been the subject of some lively exchanges in the BMJ for more than 10 years. In 1997, Marilyn Gallichan wrote, “The inappropriate use of self monitoring of glucose is wasteful of NHS resources and can cause psychological harm. There is no convincing evidence that self monitoring improves glycaemic control, nor that blood testing is necessarily better than urine testing.”4 These challenging observations were disputed by correspondents who suggested that self monitoring might help people with diabetes improve blood glucose control, avoid hypoglycaemia, improve quality of life, and enhance long term prognosis.5

The NHS Health Technology Assessment programme responded by commissioning a systematic …