Re: I am Really Miffed at my PCP


"Chris Malcolm" <cam@xxxxxxxxxxxxxxxxx> wrote in message
news:8tuneuFrlaU1@xxxxxxxxxxxxxxxxxxxxx
outsider <outsider@xxxxxxxxxxxxxxxxxxxx> wrote:
On 3/11/2011 4:22 AM, Julie Bove wrote:
"Chris Malcolm"<cam@xxxxxxxxxxxxxxxxx> wrote in message

Note that I'm referring to non-insulin users, because if you're not
injecting insulin that removes one very important high priority need
for immediate BG information. Note that the ADA considers that many
NIDDM T2s don't need to test their BGs at all, and in fact shouldn't,
because it would just worry them unnecessarily.

What? OMG! Cite for that please!!!!!!!

Don't hold your breath!

Haven't you guys noticed any of the many discussions in asd we've had
on this topic? Obviously not :-)

Actually I don't read most of your posts because I find them to be most
boring and they make no sense to me.

Here's what the ADA say in their position statement for medical
professionals [SMBG is self-monitoring of blood glucose]:

"A meta-analysis of SMBG in non.insulin-treated patients with type 2
diabetes concluded that some regimen of SMBG was associated with a
reduction in A1C of 0.4%. However, many of the studies in this
analysis also included patient education with diet and exercise
counseling and, in some cases, pharmacologic intervention, making it
difficult to assess the contribution of SMBG alone to improved control
(40). Several recent trials have called into question the clinical
utility and cost-effectiveness of routine SMBG in non.insulin-treated
patients (41.43)."

Okay... But that doesn't say that patients shouldn't test their BG.

From "Standards of Medical Care in Diabetes.2011, American Diabetes
Association, Diabetes Care December 30, 2010 vol. 34 no. Supplement 1
S11-S61"

http://care.diabetesjournals.org/content/34/Supplement_1/S11.full

Here's the three studies they cite which call into question the
utility of SMBG in non-insulin-dependent diabetics. All are available
in full free text. All have been previously discussed here.

-------- 1 -----------

"Impact of self monitoring of blood glucose in the management of
patients with non-insulin treated diabetes: open parallel group
randomised trial. BMJ 2007; 335: 132"

http://www.bmj.com/content/335/7611/132.abstract?ijkey=a4146ae1c5d3d30af295fbb4a5ca70fedc7b636e&keytype2=tf_ipsecsha

"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 well controlled non-insulin treated patients
with type 2 diabetes."

--------- 2 -------------

"Efficacy of self monitoring of blood glucose in patients with newly
diagnosed type 2 diabetes (ESMON study): randomised controlled
trial. BMJ 2008; 336: 1174.1177Efficacy of self monitoring of blood
glucose in patients with newly diagnosed type 2 diabetes (ESMON
study): randomised controlled trial. BMJ 2008; 336: 1174.1177"

http://www.bmj.com/content/336/7654/1174.abstract?ijkey=c5212d5e585bcfef5b24c9e9c3d0ddbc80a3f9ee&keytype2=tf_ipsecsha

"Conclusions: In patients with newly diagnosed type 2 diabetes self
monitoring of blood glucose concentration has no effect on glycaemic
control but is associated with higher scores on a depression
subscale."

--------- 3 -------------

"Glycaemic Education and Monitoring Trial Group. Cost effectiveness of
self monitoring of blood glucose in patients with non-insulin treated
type 2 diabetes: economic evaluation of data from the DiGEM trial. BMJ
2008; 336: 1177.1180"

http://www.bmj.com/content/336/7654/1177.abstract?ijkey=f5ecb0639ffc1d35fef643a1a27d02d826ed3409&keytype2=tf_ipsecsha

"Conclusions Self monitoring of blood glucose with or without
additional training in incorporating the results into self care was
associated with higher costs and lower quality of life in patients
with non-insulin treated type 2 diabetes. In light of this, and no
clinically significant differences in other outcomes, self monitoring
of blood glucose is unlikely to be cost effective in addition to
standardised usual care."

--

Sorry, but I don't see anywhere in there where it says we shouldn't test our
BG. Could you please specifically point that out?


.

Relevant Pages

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