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Gold, incentives and meh

Self-monitoring may be harmful

By Emma Wilkinson

Patients with type 2 diabetes should not self-monitor their condition as doing so has no benefits and can cause anxiety, researchers warn.

Their study throws into doubt the routine use of patient self-monitoring of blood glucose, after refuting suggestions that the practice improves glycaemic control.

Patients with type 2 diabetes who self-monitored did not have improved levels of HbA1c at any of the time points examined. Overall, levels averaged 6.87 per cent in those who self-monitored and 6.94 in those who did not.

The year-long trial of 184

patients also found no benefits for patient BMI.

But after corrections for age and gender, self-monitoring

appeared to increase levels of anxiety assessed on a psychological wellbeing questionnaire.

The researchers, who presented their results at the European Association for the Study of Diabetes conference in Copenhagen this week, said self-monitoring was costly to the NHS but widely advocated – despite conflicting evidence on its benefits.

Study leader Dr Maurice O'Kane, consultant chemical pathologist at Altnagelvin Hospital in Londonderry, Northern Ireland, said: 'There is no evidence from this study that patients with type 2 diabetes should be encouraged as a matter of routine to self-monitor

either in terms of improving glycaemic control or psychological wellbeing.'

A second study presented at the meeting showed that a third of patients with type 1 or 2 diabetes suffer from needle phobia and may avoid self-

monitoring as a result.

Study leader Amy Moir, diabetes specialist nurse at the

Beta Cell Diabetes Centre in London, said clinicians should be aware that 38 per cent of women and 24 per cent of men had high levels of injection anxiety with the lancet device used in self-testing.

'If patients with type 2 diabetes don't want to self-test, and are tablet controlled, we can do regular HbA1cs to assess their glycaemic control,' she added.

Dr Ahzar Farooqi, a GP in Leicester and diabetes lead for Eastern Leicester PCT, said self-monitoring was common in type 2 diabetes, but did not appear to be indicated.

'There are a few patients who may benefit – perhaps those with poor control – but they are a very select group. The vast

majority will not.'

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