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In another recent RCT (289), sMBG was not effective to reduce HbA1c in
DM 2 patients who were newly diagnosed or under the age of 70. SMBGs was
associated with worse outcomes in the depression subscale of a quality of life
questionnaire.
Appendix 9 provides information on the contents of diabetologic education
as well as additional material for patients.
RCT
1++
Summary of evidence
1+ Education in diabetes improves glycemic control to a certain extent and can have a
beneficial impact on other outcome variables (weight loss, quality of life, etc.) (79;
272-274).
1+ The measures which include an active role of the patients to take informed decisions
improve self-care and glycemic control (HbA 1c) (275).
1+ Group training on self-care strategies for DM 2 patients is very effective to improve
glycemic control, knowledge on diabetes and self-care abilities, as well as to reduce
blood pressure, body weight and the need to treat mid and long-term diabetes (280).
1+/1++ Self-management of patients with diabetes improves glycemic control (277-279). The
findings on other results suffer more variations (weight, blood pressure, lipid profile,
etc.). The Chodosh review (278) (of better quality), showed a clinically relevant effect
on the reduction of HbA1c (0.81%), without any weight differences.
2+ In the insulinised patient, the evidence to recommend the use of SMBG and insulin
dose self-adjustment comes from observational studies (283; 283), as the information
on the glucose level is useful to adjust the insulin dose, thus providing better glycemic
control (284).
1+ In diabetic patients not using insulin, the results are inconsistent. SMBG has shown
some effectiveness in the improvement of glycemic control in some studies (284;
286). Normally, the studies are carried out across motivated population and within the
context of self-managementl with more elements than SMBG (285).
1++ In DM 2 patients from primary care with acceptable glycemic control, no significant
differences were observed in HbA1c between standard care (HbA1c controlwith treatment
review every 3 months), less intensive SMBG (contacting the physician if any
abnormal values) and intensive SMBG with self-management (additional training to
interpret the results and maintain adherence to life styles, diet and exercise as well as
to medical treatment) (283; 288).
2+ Patients with lower HbA 1c baseline levels could benefit more from SMBG (287;
289).
1++ Self-analysis has not proved to be more effective in the reduction of HbA1c in newly
diagnosed DM 2 patients under 70 and it has been associated with a negative impact
on their quality of life (289).
114 CLINICAL PRACTICE GUIDELINES IN THE NHS