Title: Self-monitoring of blood glucose (SMBG) in type 2 diabetes These slides should be used in conjunction with the accompanying notes
1Self-monitoring of blood glucose (SMBG) in type
2 diabetes These slides should be used in
conjunction with the accompanying notes
2Options for local implementationNPC. Key
therapeutic topics 2010/11 Medicines management
options for local implementation. Second update
July 2011
- Review and, where appropriate, revise local use
of SMBG in type 2 diabetes mellitus to ensure
that it is in line with NICE guidance
3Key questions
- What does NICE say about SMBG in type 2 diabetes?
- What is the evidence for SMBG in type 2 diabetes?
- Are there specific groups of patients with type 2
diabetes who would benefit from SMBG? - How are we doing with prescribing?
4Type 2 diabetes management is multifactorial
Smoking
Control blood pressure
Education
Lifestyle
Control blood glucose
Individualised care of patients based on
evidence for each intervention
Statin
Aspirin
Metformin
These slides should be used in conjunction with
the accompanying notes
5What does NICE say about SMBG in type 2
diabetes? NICE Clinical Guideline 87 May 2009
- Make available to
- Those on insulin
- Those on oral medication to provide information
on hypoglycaemia - Assess changes during medication or lifestyle
changes, or illness - Ensure safety during activities, including
driving.
- Assess at least annually in a structured way
- Self-monitoring skills
- Quality and appropriate frequency of testing
- The use made of results obtained
- The impact on quality of life
- The continued benefit
- The equipment used.
6- What is the evidence for SMBG in
- type 2 diabetes?
7HTA report on SMBG in type 2 diabetesClar C, et
al. HTA 2010 Vol. 14 No. 12
- Identified 30 RCTs, although few of high quality
- Concluded that evidence suggests SMBG is of
limited clinical effectiveness in improving
glycaemic control in people with type 2 diabetes
on oral agents, or diet alone, and is therefore
unlikely to be cost-effective - SMBG may lead to improved glycaemic control only
in the context of appropriate education both
for patients and healthcare professionals on
how to respond to the data, in terms of lifestyle
and treatment adjustment - SMBG may be more effective if patients are able
to self-adjust drug treatment - Further research is required on the type of
education and feedback that are most helpful,
characteristics of patients benefiting most from
SMBG, optimal timing and frequency of SMBG, and
the circumstances under which SMBG causes anxiety
and/or depression.
8More evidence for SMBG in type 2
diabetes?Polonsky, WH, et al. Diabetes Care
2011342627, MeReC Rapid Review No. 2534
- US 12-month RCT of 483 poorly controlled
insulin-naïve type 2 diabetic patients (mean
HbA1c 8.9) - Compared a comprehensive, structured SMBG
intervention package (which encouraged patients
and doctors to work together to collect,
interpret, and appropriately use SMBG data) with
enhanced usual care - Primary end point HbA1c at 12 months
- Significantly greater reductions in mean HbA1c
with structured SMBG compared with enhanced usual
care - mean reduction in HbA1c 1.2 vs. 0.9,
respectively, P0.04 - Unclear whether 0.3 difference in HbA1c between
groups is clinically significant and enough to
justify the additional resources needed to
provide the intervention
9- Are there specific groups of patients
- with type 2 diabetes who would benefit
- from SMBG?
10NHS Diabetes Report on SMBG in non-insulin
treated patients with type 2 diabetesNHS
Diabetes. March 2010. http//www.diabetes.nhs.uk/p
ublications_and_resources/reports_and_guidance/
- SMBG should be available (with appropriate
structured education) to people receiving
sulfonylureas to identify hypoglycaemic episodes - SMBG should only be provided routinely to people
not treated with insulin or sulfonylureas where
there is agreed purpose - SMBG should be used only within a care package,
accompanied by structured education, with regular
review - individuals with non-insulin treated diabetes who
are motivated by SMBG activity and use
information to maximise effect of lifestyle and
medication should be encouraged to continue to
monitor - staff training in the use of SMBG to support
changes in lifestyle and self-adjustment of
medications is required - savings from reduction in SMBG should be used to
provide structured education and training of
professionals.
11How are we doing with prescribing? http//www.ic.n
hs.uk/pubs/prescribingdiabetes0410
COST
12Key messages
- Management of type 2 diabetes requires
individualised multifactorial care - In patients with established type 2 diabetes
whose blood glucose is relatively well-controlled
with oral drugs who monitor blood glucose
infrequently, little is to be gained in promoting
SMBG, even with an education programme - Reserve SMBG for people treated with insulin and
in some specific circumstances - such as patients at risk of hypoglycaemia during
intercurrent illness, fasting or when using
sulfonylureas - Attention and resources may be best directed to
interventions likely to make a difference to
patients symptoms and risk of macrovascular and
microvascular complications - such as support and advice around nutrition,
exercise, smoking cessation, foot care,
management of blood pressure and lipids