Self-monitoring of blood glucose: a promise still unfulfilled?

Excerpt

In the late 1970s, the introduction of self-monitoring of blood glucose (SMBG) promised a revolution in diabetes management for those taking insulin [1, 2]. It paved the way for intensified insulin therapy in allowing a patient to measure their glucose level accurately and immediately and to confirm an episode of hypoglycaemia. Its availability led directly to the DCCT and other trials that established the benefit of keeping glucose close to normal. Yet, nearly 50 years later, the evidence to support the use of SMBG in type 1 diabetes is surprisingly limited. A fairly recent systematic review found no overall improvement in blood glucose control or significant reductions in hypoglycaemia in trials involving individuals with type 1 diabetes [3]. This may reflect the lack of interest in undertaking formal randomised controlled trials (RCTs) in an area where the advantages of such technology are thought to be obvious. Nevertheless, the failure of studies to demonstrate major benefits of established technologies in terms of blood glucose control or even hypoglycaemia in type 1 diabetes emphasises the methodological challenges in this area of research. It also suggests the likely difficulty in establishing the value of SMBG in individuals with type 2 diabetes, who are at less risk of hypoglycaemia compared with those with type 1 diabetes [4] and where the link between a knowledge of current blood glucose is less obviously connected to changes in therapy. …