Does self-monitoring of blood glucose improve outcome in type 2 diabetes? The Fremantle Diabetes Study
To assess whether self-monitoring of blood glucose (SMBG) is an independent predictor of improved outcome in a community-based cohort of type 2 diabetic patients.
Materials and methods
We used longitudinal data from (1) 1,280 type 2 diabetic participants in the observational Fremantle Diabetes Study (FDS) who reported SMBG and diabetes treatment status at study entry (1993–1996), and (2) a subset of 531 participants who attended six or more annual assessments (referred to as the 5-year cohort). Diabetes-related morbidity, cardiac death and all-cause mortality were ascertained at each assessment, supplemented by linkage to the Western Australian Data Linkage System.
At baseline, 70.2% (898 out of 1,280) of type 2 patients used SMBG. During 12,491 patient-years of follow-up (mean 9.8 ± 3.5 years), 486 (38.0%) type 2 participants died (196 [15.3%] from cardiac causes). SMBG was significantly less prevalent in those who died during follow-up than in those who were still alive at the end of June 2006 (65.4 vs 73.0%, p = 0.005). In Cox proportional hazards modelling, after adjustment for confounding and explanatory variables, SMBG was not independently associated with all-cause mortality, but was associated with a 79% increased risk of cardiovascular mortality in patients not treated with insulin. For the 5-year cohort, time-dependent SMBG was independently associated with a 48% reduced risk of retinopathy.
SMBG was not independently associated with improved survival. Inconsistent findings relating to the association of SMBG with cardiac death and retinopathy may be due to confounding, incomplete covariate adjustment or chance.
- Gray, A, Raikou, M, McGuire, A (2000) Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised control trial (UKPDS 41). BMJ 320: pp. 1373-1378 CrossRef
- Ipp, E, Aquino, RL, Christenson, P (2005) Point: self-monitoring of blood glucose in type 2 diabetic patients not receiving insulin. The sanguine approach. Diabetes Care 28: pp. 1528-1530
- Davidson, MB (2005) Counterpoint: self-monitoring of blood glucose in type 2 diabetic patients not receiving insulin. A waste of money. Diabetes Care 28: pp. 1531-1533
- Martin, S, Schneider, B, Heinemann, L (2006) Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study. Diabetologia 49: pp. 271-278 CrossRef
- Davis, WA, Bruce, DG, Davis, TME (2006) Is self-monitoring of blood glucose appropriate for all type 2 diabetic patients? The Fremantle Diabetes Study. Diabetes Care 29: pp. 1764-1770 CrossRef
- Davis, TM, Zimmet, P, Davis, WA, Bruce, DG, Fida, S, Mackay, I (2000) Autoantibodies to glutamic acid decarboxylase in diabetic patients from a multiethnic Australian community: the Fremantle Diabetes Study. Diabet Med 17: pp. 667-674 CrossRef
- Norman, PE, Davis, WA, Bruce, DG, Davis, TM (2006) Peripheral arterial disease and risk of cardiac death in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care 29: pp. 575-580 CrossRef
- Holman, CD, Bass, AJ, Rouse, IL, Hobbs, MS (1999) Population-based linkage of health records in Western Australia: development of a health services research linked database. Aust N Z J Public Health 23: pp. 453-459
- Bradshaw, PJ, Jamrozik, K, Jelfs, P, Le, M (2000) Mobile Australians: a moving target for epidemiologists. Med J Aust 172: pp. 566
- Davis, WA, Norman, PE, Bruce, DG, Davis, TM (2006) Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: the Fremantle Diabetes Study. Diabetologia 49: pp. 2634-2641 CrossRef
- Does self-monitoring of blood glucose improve outcome in type 2 diabetes? The Fremantle Diabetes Study
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Volume 50, Issue 3 , pp 510-515
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