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Δεν προσφέρει όφελος ο αυτοέλεγχος γλυκόζης σε διαβητικούς υπό αγωγή με δισκία.

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Argirios Argiriou:
Φρεσκότατη μελέτη, δημοσιευμένη σε ένα από τα πιο έγκυρα Ιατρικά περιοδικά της Γης, που λέει ότι ο αυτοέλεγχος γλυκόζης σε Διαβητικούς τύπου 2 που δεν κάνουν ινσουλίνη (η μεγάλη πλειοψηφία των Διαβητικών δηλαδή) δεν παρέχει κανένα ουσιαστικό όφελος.

( Είναι κάτι που μας το λέγαν εδώ και χρόνια όταν δούλευα στην Σουηδία... )

 Με άλλα λόγια ο ΕΟΠΥΥ πετάει εκατομμύρια €/έτος, σε ταινίες, σκαρφιστήρες κτλ...)





Original Investigation

June 10, 2017

Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings

A Randomized Trial

Laura A. Young, MD, PhD1,2; John B. Buse, MD, PhD1; Mark A. Weaver, PhD3; et alMaihan B. Vu, DrPH, MPH4; C. Madeline Mitchell, MURP2; Tamara Blakeney, BS2; Kimberlea Grimm, BAS2; Jennifer Rees, RN, CPF2; Franklin Niblock, BS5; Katrina E. Donahue, MD, MPH2,6; for the Monitor Trial Group

Author Affiliations Article Information

JAMA Intern Med. Published online June 10, 2017. doi:10.1001/jamainternmed.2017.1233
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Author Video Interviews(5:03)
Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes
Author Interviews(5:00)
Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes
(2:07)
Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes
Key Points
Question  Is self-monitoring blood glucose levels effective for people with non–insulin-treated type 2 diabetes in terms of improving either hemoglobin A1c levels or health-related quality of life (HRQOL) in primary care practice?

Findings  In this pragmatic randomized clinical trial that included 450 patients randomized to 1 of 3 groups: no self-monitoring of blood glucose (SMBG), once-daily SMBG, and once-daily SMBG with enhanced patient feedback. There were no significant differences in glycemic control across all groups, nor were there significant differences found in HRQOL.

Meaning  Routine self-monitoring of blood glucose levels does not significantly improve hemoglobin A1c levels or HRQOL for most patients with non–insulin-treated type 2 diabetes; patients and clinicians should consider the specifics of each clinical situation as they decide whether to test or not to test.

Abstract
Importance  The value of self-monitoring of blood glucose (SMBG) levels in patients with non–insulin-treated type 2 diabetes has been debated.

Objective  To compare 3 approaches of SMBG for effects on hemoglobin A1c levels and health-related quality of life (HRQOL) among people with non–insulin-treated type 2 diabetes in primary care practice.

Design, Setting, and Participants  The Monitor Trial study was a pragmatic, open-label randomized trial conducted in 15 primary care practices in central North Carolina. Participants were randomized between January 2014 and July 2015. Eligible patients with type 2 non–insulin-treated diabetes were: older than 30 years, established with a primary care physician at a participating practice, had glycemic control (hemoglobin A1c) levels higher than 6.5% but lower than 9.5% within the 6 months preceding screening, as obtained from the electronic medical record, and willing to comply with the results of random assignment into a study group. Of the 1032 assessed for eligibility, 450 were randomized.

Interventions  No SMBG, once-daily SMBG, and once-daily SMBG with enhanced patient feedback including automatic tailored messages delivered via the meter.

Main Outcomes and Measures  Coprimary outcomes included hemoglobin A1c levels and HRQOL at 52 weeks.

Results  A total of 450 patients were randomized and 418 (92.9%) completed the final visit. There were no significant differences in hemoglobin A1c levels across all 3 groups (P = .74; estimated adjusted mean hemoglobin A1c difference, SMBG with messaging vs no SMBG, −0.09%; 95% CI, −0.31% to 0.14%; SMBG vs no SMBG, −0.05%; 95% CI, −0.27% to 0.17%). There were also no significant differences found in HRQOL. There were no notable differences in key adverse events including hypoglycemia frequency, health care utilization, or insulin initiation.

Conclusions and Relevance  In patients with non–insulin-treated type 2 diabetes, we observed no clinically or statistically significant differences at 1 year in glycemic control or HRQOL between patients who performed SMBG compared with those who did not perform SMBG. The addition of this type of tailored feedback provided through messaging via a meter did not provide any advantage in glycemic control.



Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

Argirios Argiriou:
June 12, 2017

More Evidence That Glucose Self-Monitoring May Not Improve Outcomes in Non-Insulin-Dependent Type 2 Diabetes.

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

A new study adds to the evidence against routine blood glucose self-monitoring in patients with non-insulin-treated type 2 diabetes. The findings were published in JAMA Internal Medicine and presented at the American Diabetes Association's annual meeting.

Some 450 adults with non-insulin-dependent diabetes and hemoglobin A1c levels between 6.5% and 9.5% were randomized to one of three groups: no glucose self-monitoring; standard once-daily monitoring; or "enhanced" once-daily monitoring in which patients received tailored messages aimed at education and motivation.

At 1 year, the two primary outcomes — HbA1c improvements and health-related quality of life — did not differ across the groups. "This null result," the researchers note, "occurred despite training participants and primary care clinicians on the use and interpretation of the meter results."

They add that "more active engagement of both patients and clinicians may have improved patient outcomes, although this would have diminished the pragmatic nature of this study." They conclude that the results "suggest that glucose monitoring in patients with non-insulin-treated [type 2 diabetes] should not be routine."

LINK(S):

JAMA Internal Medicine article (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

JAMA Internal Medicine editor's note (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Background: Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος(Your NEJM Journal Watch registration required)

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

Denominator:
Στη χώρα μας μπορεί κανείς να εκδόσει 3 δίμηνες γνωματεύσεις με 50 ταινίες την καθε μία σε ασθενή με ήπιο Σ/Δ τύπου ΙΙ που παίρνει και μισό χάπι (500mg) μετφορμίνη.

pzogr:
Ενώ δεν έχω αμφιβολία ότι για την πλειονότητα των ασθενών αυτό είναι πραγματικό, πιστεύω ότι δεν μπορεί να γενικευτεί σαν συμπέρασμα. Η γιαγιά που ξέρει τα φάρμακα μόνο με το χρώμα τους και μετρά ψυχαναγκαστικά το σάκχαρο δεν θα ωφεληθεί σε τίποτα. Κάθε φορά που γράφω τις ταινίες "που δικαιούται" εκνευρίζομαι, αλλά πρακτικά δεν μπορώ να κάνω κάτι γι'αυτό. Ένας συνεννόησιμος ασθενής όμως σίγουρα μπορεί να βελτιωθεί τουλάχιστον ως προς τους στόχους, ιδίως όταν οι παρεμβάσεις είναι εύκολες. πχ ασθενής με γλυκοζυλιωμένη γύρω στο 7,5% που με ένα (οποιοδήποτε) επιπλέον φάρμακο θα φτάσει το στόχο. Μεγάλη βελτίωση μπορούν επίσης να παρουσιάσουν ασθενείς με πολύ ψηλή γλυκοζυλιωμένη, που δέχονται τη θεραπεία (και την εφαρμόζουν βέβαια) με ινσουλίνη.

Εκτός βέβαια αν αμφισβητούμε τη λογική και αποτελεσματικότητα της επίτευξης των στόχων...

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