Skip to main content
PMC home page
British Medical Journal (Clinical Research Ed.) logoLink to British Medical Journal (Clinical Research Ed.)
. 1982 Oct 30;285(6350):1233–1240. doi: 10.1136/bmj.285.6350.1233

Intensive attention improves glycaemic control in insulin-dependent diabetes without further advantage from home blood glucose monitoring: results of a controlled trial.

R Worth, P D Home, D G Johnston, J Anderson, L Ashworth, J M Burrin, D Appleton, C Binder, K G Alberti
PMCID: PMC1499792  PMID: 6812820

Abstract

Forty-six diabetics treated with twice-daily insulin were seen every two weeks for six months in an intensive education programme aided by regular home urine glucose testing. Control was improved with a decrease in 24-hour urinary glucose excretion (median 138 mmol/24 h (24.8 g/24 h) falling to 70 mmol/24 h (12.6 g/24 h); p less than 0.002), glycosylated haemoglobin concentration (mean 11.4 +/- SD 2.3% falling to 10.4 +/- 1.5%; p less than 0.001), and Diastix score (median 3.0 falling to 1.3; p less than 0.001). There was no reported increase in hypoglycaemia. Thirty-eight of the diabetics proceeded to a nine-month randomised cross-over study of the effect on blood glucose control of monitoring urinary glucose or blood glucose measured visually or by a reflectance meter using appropriate reagent strips. No further improvement in control was observed after home blood glucose monitoring. Nevertheless, 29 out of 37 patients preferred blood to urine glucose monitoring. During both the education and cross-over studies there was evidence of an initial improvement in control followed by deterioration. This was independent of the monitoring method used in the cross-over period and may have been due to waning enthusiasm. Despite patient enthusiasm and other reports to the contrary, home blood glucose monitoring offered no improvement in control over intensive attention and conventional urine glucose monitoring.

Full text

PDF
1237

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BEASER S. Teaching the diabetic patient. Diabetes. 1956 Mar-Apr;5(2):146–149. doi: 10.2337/diab.5.2.146. [DOI] [PubMed] [Google Scholar]
  2. Barbosa J., Menth L., Schumacher G., Johnson S., Najarian J. Feasibility of blood glucose self-monitoring in unstable insulin-dependent diabetes. Diabetes Care. 1980 Jan-Feb;3(1):155–159. doi: 10.2337/diacare.3.1.155. [DOI] [PubMed] [Google Scholar]
  3. Bernstein R. K. Virtually continuous euglycemia for 5 yr in a labile juvenile-onset diabetic patient under noninvasive closed-loop control. Diabetes Care. 1980 Jan-Feb;3(1):140–143. doi: 10.2337/diacare.3.1.140. [DOI] [PubMed] [Google Scholar]
  4. Cahill G. F., Jr, Etzwiler L. D., Freinkel N. Editorial: "Control" and diabetes. N Engl J Med. 1976 Apr 29;294(18):1004–1005. doi: 10.1056/NEJM197604292941811. [DOI] [PubMed] [Google Scholar]
  5. Collier B. N., Jr, Etzwiler D. D. Comparative study of diabetes knowledge among juvenile diabetics and their parents. Diabetes. 1971 Jan;20(1):51–57. doi: 10.2337/diab.20.1.51. [DOI] [PubMed] [Google Scholar]
  6. Danowski T. S., Sunder J. H. Jet injection of insulin during self-monitoring of blood glucose. Diabetes Care. 1978 Jan-Feb;1(1):27–33. doi: 10.2337/diacare.1.1.27. [DOI] [PubMed] [Google Scholar]
  7. Dudley J. D. The diabetes educator's role in teaching the diabetic patient. Diabetes Care. 1980 Jan-Feb;3(1):127–133. doi: 10.2337/diacare.3.1.127. [DOI] [PubMed] [Google Scholar]
  8. Etzwiler D. D., Robb J. R. Evaluation of programmed education among juvenile diabetics and their families. Diabetes. 1972 Sep;21(9):967–971. doi: 10.2337/diab.21.9.967. [DOI] [PubMed] [Google Scholar]
  9. Etzwiler D. D. Who's teaching the diabetic? Diabetes. 1967 Feb;16(2):111–117. doi: 10.2337/diab.16.2.111. [DOI] [PubMed] [Google Scholar]
  10. Faber O. K., Markussen J., Naithani V. K., Binder C. Production of antisera to synthetic benzyloxycarbonyl-C-peptide of human proinsulin. Hoppe Seylers Z Physiol Chem. 1976 Jun;357(6):751–757. doi: 10.1515/bchm2.1976.357.1.751. [DOI] [PubMed] [Google Scholar]
  11. Flückiger R., Winterhalter K. H. In vitro synthesis of hemoglobin AIc. FEBS Lett. 1976 Dec 1;71(2):356–360. doi: 10.1016/0014-5793(76)80969-6. [DOI] [PubMed] [Google Scholar]
  12. Gabbay K. H., Hasty K., Breslow J. L., Ellison R. C., Bunn H. F., Gallop P. M. Glycosylated hemoglobins and long-term blood glucose control in diabetes mellitus. J Clin Endocrinol Metab. 1977 May;44(5):859–864. doi: 10.1210/jcem-44-5-859. [DOI] [PubMed] [Google Scholar]
  13. Gonen B., Rubenstein A., Rochman H., Tanega S. P., Horwitz D. L. Haemoglobin A1: An indicator of the metabolic control of diabetic patients. Lancet. 1977 Oct 8;2(8041):734–737. doi: 10.1016/s0140-6736(77)90237-9. [DOI] [PubMed] [Google Scholar]
  14. Graber A. L., Christman B. G., Alogna M. T., Davidson J. K. Evaluation of diabetes patient-education programs. Diabetes. 1977 Jan;26(1):61–64. doi: 10.2337/diab.26.1.61. [DOI] [PubMed] [Google Scholar]
  15. James R. C., Chase G. R. Evaluation of some commonly used semiquantitative methods for urinary glucose and ketone determinations. Diabetes. 1974 May;23(5):474–479. doi: 10.2337/diab.23.5.474. [DOI] [PubMed] [Google Scholar]
  16. Jovanovic L., Peterson C. M. The clinical utility of glycosylated hemoglobin. Am J Med. 1981 Feb;70(2):331–338. doi: 10.1016/0002-9343(81)90770-1. [DOI] [PubMed] [Google Scholar]
  17. Kaufmann R. L., Assal JPh, Soeldner J. S., Wilmshurst E. G., Lemaire J. R., Gleason R. E., White P. Plasma lipid levels in diabetic children. Effect of diet restricted in cholesterol and saturated fats. Diabetes. 1975 Jul;24(7):672–679. doi: 10.2337/diab.24.7.672. [DOI] [PubMed] [Google Scholar]
  18. Koenig R. J., Peterson C. M., Jones R. L., Saudek C., Lehrman M., Cerami A. Correlation of glucose regulation and hemoglobin AIc in diabetes mellitus. N Engl J Med. 1976 Aug 19;295(8):417–420. doi: 10.1056/NEJM197608192950804. [DOI] [PubMed] [Google Scholar]
  19. Kubilis P., Rosenbloom A. L., Lezotte D., Silverstein J. H., Cimino P., Rosenbloom E. D., Harvey C. Comparison of blood glucose testing using reagent strips with and without a meter (Chemstrips bG and Dextrostix/Dextrometer). Diabetes Care. 1981 May-Jun;4(3):417–419. doi: 10.2337/diacare.4.3.417. [DOI] [PubMed] [Google Scholar]
  20. Miller L. V., Goldstein J. More efficient care of diabetic patients in a county-hospital setting. N Engl J Med. 1972 Jun 29;286(26):1388–1391. doi: 10.1056/NEJM197206292862605. [DOI] [PubMed] [Google Scholar]
  21. Molnar G. D., Marien G. J., Hunter A. N., Harley C. H. Methods of assessing diabetic control. Diabetologia. 1979 Jul;17(1):5–16. doi: 10.1007/BF01222971. [DOI] [PubMed] [Google Scholar]
  22. Raskin P. Diabetic regulation and its relationship to microangiopathy. Metabolism. 1978 Feb;27(2):235–252. doi: 10.1016/0026-0495(78)90169-5. [DOI] [PubMed] [Google Scholar]
  23. Reeves M. L., Forhan S. E., Skyler J. S., Peterson C. M. Comparison of methods for blood glucose monitoring. Diabetes Care. 1981 May-Jun;4(3):404–406. doi: 10.2337/diacare.4.3.404. [DOI] [PubMed] [Google Scholar]
  24. SCHLICHTKRULL J., MUNCK O., JERSILD M. THE M-VALVE, AN INDEX OF BLOOD-SUGAR CONTROL IN DIABETICS. Acta Med Scand. 1965 Jan;177:95–102. doi: 10.1111/j.0954-6820.1965.tb01810.x. [DOI] [PubMed] [Google Scholar]
  25. Schiffrin A., Belmonte M. M. Comparison between continuous subcutaneous insulin infusion and multiple injections of insulin. A one-year prospective study. Diabetes. 1982 Mar;31(3):255–264. doi: 10.2337/diab.31.3.255. [DOI] [PubMed] [Google Scholar]
  26. Service F. J., Molnar G. D., Rosevear J. W., Ackerman E., Gatewood L. C., Taylor W. F. Mean amplitude of glycemic excursions, a measure of diabetic instability. Diabetes. 1970 Sep;19(9):644–655. doi: 10.2337/diab.19.9.644. [DOI] [PubMed] [Google Scholar]
  27. Service F. J., Molnar G. D., Taylor W. F. Urine glucose analyses during continuous. JAMA. 1972 Oct 16;222(3):294–298. [PubMed] [Google Scholar]
  28. Shapiro B., Savage P. J., Lomatch D., Gniadek T., Forbes R., Mitchell R., Hein K., Starr R., Nutter M., Scherdt B. A comparison of accuracy and estimated cost of methods for home blood glucose monitoring. Diabetes Care. 1981 May-Jun;4(3):396–403. doi: 10.2337/diacare.4.3.396. [DOI] [PubMed] [Google Scholar]
  29. Skyler J. S., Lasky I. A., Skyler D. L., Robertson E. G., Mintz D. H. Home blood glucose monitoring as an aid in diabetes management. Diabetes Care. 1978 May-Jun;1(3):150–157. [PubMed] [Google Scholar]
  30. Skyler J. S., Skyler D. L., Seigler D. E., O'Sullivan M. J. Algorithms for adjustment of insulin dosage by patients who monitor blood glucose. Diabetes Care. 1981 Mar-Apr;4(2):311–318. doi: 10.2337/diacare.4.2.311. [DOI] [PubMed] [Google Scholar]
  31. Sterky G. C., Persson B. E., Larsson Y. A. Dietary fats, the diurnal blood lipids and ketones in juvenile diabetes. Diabetologia. 1966 Jun;2(1):14–19. doi: 10.1007/BF01106970. [DOI] [PubMed] [Google Scholar]
  32. Stubbs S. M., Brudenell J. M., Pyke D. A., Watkins P. J., Stubbs W. A., Alberti K. G. Management of the pregnant diabetic: home or hospital, with or without glucose meters? Lancet. 1980 May 24;1(8178):1122–1124. doi: 10.1016/s0140-6736(80)91564-0. [DOI] [PubMed] [Google Scholar]
  33. Suarez L., Barrett-Connor E. Seasonal variation in fasting plasma glucose levels in man. Diabetologia. 1982 Apr;22(4):250–253. doi: 10.1007/BF00281300. [DOI] [PubMed] [Google Scholar]
  34. Svendsen P. A., Christiansen J. S., Søegaard U., Welinder B. S., Nerup J. Rapid changes in chromatographically determined haemoglobin A1c induced by short-term changes in glucose concentration. Diabetologia. 1980 Aug;19(2):130–136. doi: 10.1007/BF00421859. [DOI] [PubMed] [Google Scholar]
  35. Sönksen P. H., Judd S. L., Lowy C. Home monitoring of blood-glucose. Method for improving diabetic control. Lancet. 1978 Apr 8;1(8067):729–732. doi: 10.1016/s0140-6736(78)90854-1. [DOI] [PubMed] [Google Scholar]
  36. Tattersall R. B. Home blood glucose monitoring. Diabetologia. 1979 Feb;16(2):71–74. doi: 10.1007/BF01225453. [DOI] [PubMed] [Google Scholar]
  37. Tchobroutsky G. Relation of diabetic control to development of microvascular complications. Diabetologia. 1978 Sep;15(3):143–152. doi: 10.1007/BF00421230. [DOI] [PubMed] [Google Scholar]
  38. Walford S., Gale E. A., Allison S. P., Tattersall R. B. Self-monitoring of blood-glucose. Improvement of diabetic control. Lancet. 1978 Apr 8;1(8067):732–735. doi: 10.1016/s0140-6736(78)90855-3. [DOI] [PubMed] [Google Scholar]
  39. Whitehouse F. W., Whitehouse I. J., Smith J., Hohl R. D. Teaching the person with diabetes: experience with a follow-up session. Diabetes Care. 1979 Jan-Feb;2(1):35–38. doi: 10.2337/diacare.2.1.35. [DOI] [PubMed] [Google Scholar]
  40. Worth R. C., Harrison K., Anderson J., Johnston D. G., Alberti K. G. A comparison study of blood glucose test strips. Diabetes Care. 1981 May-Jun;4(3):407–411. doi: 10.2337/diacare.4.3.407. [DOI] [PubMed] [Google Scholar]

Articles from British Medical Journal (Clinical research ed.) are provided here courtesy of BMJ Publishing Group

RESOURCES