Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial
Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial
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DOI：
10.1136/bmj.39247.447431.be
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发表时间：
2007-07-21
影响因子：
105.7
通讯作者：
Neil, Andrew
中科院分区：
文献类型：
--
作者：
Farmer, Andrew;Wade, Alisha;Neil, Andrew
目的确定自我监测（单独或指导将结果纳入自我护理）在改善非胰岛素治疗的2型糖尿病患者的血糖控制方面是否比常规护理更有效。设计三臂，开放，平行组随机试验，在牛津郡和南约克郡设置48个普通诊所，参与者453名非胰岛素治疗的2型糖尿病患者（平均年龄65.7岁），中位持续时间为3年，平均血红蛋白A（1c）水平为7.5%。干预标准化常规护理，每三个月测量HbA（1c）作为对照组（n=152）;血糖自我监测，建议患者联系他们的医生解释结果，除了常规护理（n=150）;和血糖自我监测，并对患者进行解释和应用结果的额外培训，以增强动力并保持对结果12个月时，三组间HbA（1c）水平（校正基线HbA（1c）水平）差异无统计学意义（P=0.12）。对照组和较低强度自我监测组之间HbA（1c）水平从基线至12个月的未校正平均变化差异为-0.14%（95%可信区间为-0.35%至0.07%），对照组与强化自我监控组之间的差异为-0至17%结论在血糖控制良好的非胰岛素治疗的2型糖尿病患者中，自我监测血糖（有或没有将监测结果纳入自我护理的指导）与常规护理相比，在改善血糖控制方面的效果并不令人信服。
Objective To determine whether self monitoring, alone or with instruction in incorporating the results into self care, is more effective than usual care in improving glycaemic control in non-insulin treated patients with type 2 diabetes.Design Three arm, open, parallel group randomised trial.Setting 48 general practices in Oxfordshire and South Yorkshire.Participants 453 patients with non-insulin treated type 2 diabetes (mean age 65.7 years) for a median duration of three years and a mean haemoglobin A(1c) level of 7.5%. Interventions Standardised usual care with measurements of HbA(1c) every three months as the control group (n=152); blood glucose self monitoring with advice for patients to contact their doctor for interpretation of results, in addition to usual care (n=150); and blood glucose self monitoring with additional training of patients in interpretation and application of the results to enhance motivation and maintain adherence to a healthy lifestyle (n=151).Main outcome measure HbA(1c) level measured at 12 months.Results At 12 months the differences in HbA(1c) level between the three groups (adjusted for baseline HbA(1c), level) were not statistically significant (P=0.12). The difference in unadjusted mean change in HbA(1c) level from baseline to 12 months between the control and less intensive self monitoring groups was -0.14% (95% confidence interval -0.35% to 0.07%) and between the control and more intensive self monitoring groups was -0-17% (-0.37% to 0.03%).Conclusions Evidence is not convincing of an effect of self monitoring blood glucose, with or without instruction in incorporating findings into self care, in improving glycaemic control compared with usual care in reasonably welt controlled non-insulin treated patients with type 2 diabetes.