Editing Blood glucose monitoring (section)

==Effectiveness==
For patients with [[diabetes mellitus type 2]], the importance of monitoring and the optimal frequency of monitoring are not clear. A 2011 study found no evidence that blood glucose monitoring leads to better patient outcomes in actual practice.<ref>{{cite journal | vauthors = Sidorenkov G, Haaijer-Ruskamp FM, de Zeeuw D, Bilo H, Denig P | title = Review: relation between quality-of-care indicators for diabetes and patient outcomes: a systematic literature review | journal = Medical Care Research and Review | volume = 68 | issue = 3 | pages = 263–89 | date = June 2011 | pmid = 21536606 | doi = 10.1177/1077558710394200 | s2cid = 22438556 | url = https://pure.rug.nl/ws/files/6761969/Sidorenkov_2011_Med_Care_Res_Rev.pdf | hdl = 11370/e1e98ce8-dc04-4fa2-b068-eed2f639b0c3 | hdl-access = free }}</ref> Randomized controlled trials found that self-monitoring of blood glucose did not improve [[glycated hemoglobin]] (HbA1c) among "reasonably well controlled non-insulin treated patients with type 2 diabetes"<ref name="pmid17591623">{{cite journal | vauthors = Farmer A, Wade A, Goyder E, Yudkin P, French D, Craven A, Holman R, Kinmonth AL, Neil A | title = Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial | journal = BMJ | volume = 335 | issue = 7611 | pages = 132 | date = July 2007 | pmid = 17591623 | pmc = 1925177 | doi = 10.1136/bmj.39247.447431.BE }}</ref> or lead to significant changes in quality of life.<ref name="Glucose Self-monitoring in Non-Insu">{{cite journal | vauthors = Young LA, Buse JB, Weaver MA, Vu MB, Mitchell CM, Blakeney T, Grimm K, Rees J, Niblock F, Donahue KE | title = Glucose Self-monitoring in Non-Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings: A Randomized Trial | journal = JAMA Internal Medicine | volume = 177 | issue = 7 | pages = 920–929 | date = July 2017 | pmid = 28600913 | pmc = 5818811 | doi = 10.1001/jamainternmed.2017.1233 }}</ref>  However a recent meta-analysis of 47 randomized controlled trials encompassing 7677 patients showed that self-care management intervention improves glycemic control in diabetics, with an estimated 0.36% (95% CI, 0.21–0.51) reduction in their glycated hemoglobin values.<ref>{{cite journal | vauthors = Minet L, Møller S, Vach W, Wagner L, Henriksen JE | title = Mediating the effect of self-care management intervention in type 2 diabetes: a meta-analysis of 47 randomised controlled trials | journal = Patient Education and Counseling | volume = 80 | issue = 1 | pages = 29–41 | date = July 2010 | pmid = 19906503 | doi = 10.1016/j.pec.2009.09.033 }}</ref> Furthermore, a recent study showed that patients described as being "Uncontrolled Diabetics" (defined in this study by HbA1C levels >8%) showed a statistically significant decrease in the HbA1C levels after a 90-day period of seven-point self-monitoring of blood glucose (SMBG) with a relative risk reduction (RRR) of 0.18% (95% CI, 0.86–2.64%, p<.001).<ref>{{cite journal | vauthors = Khamseh ME, Ansari M, Malek M, Shafiee G, Baradaran H | title = Effects of a structured self-monitoring of blood glucose method on patient self-management behavior and metabolic outcomes in type 2 diabetes mellitus | journal = Journal of Diabetes Science and Technology | volume = 5 | issue = 2 | pages = 388–93 | date = March 2011 | pmid = 21527110 | pmc = 3125933 | doi = 10.1177/193229681100500228 }}</ref> Regardless of lab values or other numerical parameters, the purpose of the clinician is to improve quality of life and patient outcomes in diabetic patients. A recent study included 12 randomized controlled trials and evaluated outcomes in 3259 patients. The authors concluded through a qualitative analysis that SMBG on quality of life showed no effect on patient satisfaction or the patients' health-related quality of life.  Furthermore, the same study identified that patients with type 2 diabetes mellitus diagnosed greater than one year prior to initiation of SMBG, who were not on insulin, experienced a statistically significant reduction in their HbA1C of 0.3% (95% CI, -0.4 –  -0.1) at six months follow up, but a statistically insignificant reduction of 0.1% (95% CI, -0.3 – 0.04) at twelve months follow up.  Conversely, newly diagnosed patients experienced a statistically significant reduction of 0.5% (95% CI, -0.9 – -0.1) at 12 months follow up.<ref>{{cite journal | vauthors = Malanda UL, Welschen LM, Riphagen II, Dekker JM, Nijpels G, Bot SD | title = Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD005060 | date = January 2012 | pmid = 22258959 | doi = 10.1002/14651858.CD005060.pub3 | veditors = Malanda UL | hdl = 1871/48558 | s2cid = 205176936 | url = https://research.vu.nl/ws/files/719659/300472.pdf }}</ref> A recent study found that a treatment strategy of intensively lowering blood sugar levels (below 6%) in patients with additional [[cardiovascular disease]] risk factors poses more harm than benefit.<ref>{{cite journal | vauthors = Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH, Probstfield JL, Simons-Morton DG, Friedewald WT | title = Effects of intensive glucose lowering in type 2 diabetes | journal = The New England Journal of Medicine | volume = 358 | issue = 24 | pages = 2545–59 | date = June 2008 | pmid = 18539917 | pmc = 4551392 | doi = 10.1056/NEJMoa0802743 }}</ref>  For type 2 diabetics who are not on insulin, exercise and diet are the best tools.{{citation needed|reason=Has it been demonstrated that diet/exercise are the ''best'' tools?|date=April 2017}} Blood glucose monitoring is, in that case, simply a tool to evaluate the success of diet and exercise. Insulin-dependent type 2 diabetics do not need to monitor their blood sugar as frequently as type 1 diabetics.<ref>{{Cite web|title=My Site - Chapter 9: Monitoring Glycemic Control|url=http://guidelines.diabetes.ca/cpg/chapter9#sec2|access-date=2021-01-25|website=guidelines.diabetes.ca|archive-date=12 April 2022|archive-url=https://web.archive.org/web/20220412130318/http://guidelines.diabetes.ca/cpg/chapter9#sec2|url-status=dead}}</ref> In a recent systematic review with meta-analysis, about glycaemia monitoring in critical patients who are haemodynamically unstable and require intensive monitoring of glycaemia it concluded that should be undertaken using arterial blood samples and POC blood gas analysers, as this is more reliable and is not affected by the variability of different confusion factors. Determining glycaemia in capillary blood using glucometry may be suitable in stable patients or when close monitoring of glycaemia is not required.