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Doubts on diabetes self-management

New research has questioned the value of patient self-management in those with well-controlled type 2 diabetes.

The study, published online by the BMJ, threw doubt on the clinical effectiveness of self-monitoring and questioned whether self-care schemes were cost-effective.

The researchers called for current diabetes guidelines promoting patient self-management to be reviewed. The team from the department of primary health care at the University of Oxford studied 453 patients with non-insulin dependent diabetes from 48 general practices.

One group received standard care, one had extra clinical guidance from a GP and one self-monitored intensively.After 12 months, the researchers found no significant improvement in glycaemic control, as measured by HbA1c levels, between the three groups.

Self-monitored patients did have lower total cholesterol and the ratio of total to HDL cholesterol, but suffered 43 grade two hypoglycaemic events, compared with 33 in the GP intervention group and 14 in standard care controls.

Study leader Dr Andrew Farmer, a lecturer in primary health care at the University of Oxford, concluded: 'Routine self-monitoring of blood glucose for patients with reasonably well-controlled non-insulin treated type 2 diabetes seems to offer, at best, small advantages

'It's not well-accepted, and the cost, effort and time involved in the procedures may be better directed to supporting other health-related behaviours.'

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