Cited by 326Diabetes Management and ResearchDiabetes Management and EducationDiabetes Treatment and Management

Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial

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O’Kane, Maurice J, Bunting, Brendan, Copeland, Margaret, Coates, Vivien E·2008·BMJ

Abstract

OBJECTIVES: To assess the effect of self monitoring of blood glucose concentrations on glycaemic control and psychological indices in patients with newly diagnosed type 2 diabetes mellitus. DESIGN: Prospective randomised controlled trial of self monitoring versus no monitoring (control). SETTING: Hospital diabetes clinics. PARTICIPANTS: 184 (111 men) people aged <70 with newly diagnosed type 2 diabetes referred to the participating diabetes clinics. Major exclusion criteria were secondary diabetes, insulin treatment, previous self monitoring of blood glucose. INTERVENTIONS: Participants were randomised to self monitoring or no monitoring (control) groups for one year with follow-up at three monthly intervals. Both groups underwent an identical structured core education programme. The self monitoring group received additional education on monitoring. MAIN OUTCOME MEASURES: Between group differences in HbA(1c), psychological indices, use of oral hypoglycaemic drugs, body mass index (BMI), and reported hypoglycaemia rates. RESULTS: 96 patients (55 men) were randomised to monitoring and 88 (56 men) to control. There were no baseline differences in mean (SD) age (57.7 (11.0) in monitoring group v 60.9 (11.5) in control group) or HbA(1c) (8.8 (2.1)% v 8.6 (2.3)%, respectively). Those in the monitoring group had a higher baseline BMI (34 (7) v 32 (6.2)). There were no significant differences between groups at any time point (12 months values given) in HbA(1c) (6.9 (0.8)% v 6.9 (1.2)%, P=0.69; 95% confidence interval for difference -0.25% to 0.38%), BMI (33.1 (6.4) v 31.8 (6.0); adjusted for baseline BMI, P=0.32), use of oral hypoglycaemic drugs, or reported incidence of hypoglycaemia. Monitoring was associated with a 6% higher score on the depression subscale of the well-being questionnaire (P=0.01). 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. TRIAL REGISTRATION: ISRCTN 49814766.

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  • In a retrospective analysis, frequency of blood glucose monitoring has been shown to predict A1C levels.

    “Frequency of BGM (in a retrospective analysis) has been shown to be predictive of A1C levels.142–146”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [144]

    The Abstract describes ESMON as a prospective randomised trial, not a retrospective analysis. The Outcome measures section reports no significant HbA1c difference between the monitoring and no-monitoring groups; although the Randomisation section defines monitoring-frequency compliance, the paper does not report that frequency predicted HbA1c. (LLM, conf=0.82)

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  • Current evidence on SMBG in insulin-naïve type 2 diabetic patients is mixed, with some studies showing significant glycemic benefits and others showing no significant benefits.

    “Current evidence in this latter population is mixed, with some studies pointing to significant glycemic benefits resulting from SMBG use (8–10), while others have shown no significant benefits (11–13).”
  • The ESMON trial found no benefit of SMBG on glycemic control but higher depression subscale scores in newly diagnosed non-insulin-treated diabetes.

    “The later ESMON study (109), a randomized controlled trial of SMBG in newly diagnosed people with diabetes not treated with insulin, found no benefit of SMBG on glycemic control but did find higher scores on a depression subscale.”
  • Structured SMBG is necessary to allow for immediate treatment decisions, while the use of glycated hemoglobin (HbA1c) as an estimator of long-term quality of glycemic control is insufficient in that regard.

    “Structured SMBG is necessary to allow for immediate treatment decisions while the use of glycated hemoglobin (HbA1c) as an estimator of long-term quality of glycemic control is insufficient in that regard [8].”
  • Studies have shown no or only a short-term benefit (≤ 6 months) of structured blood glucose measurements for people with diabetes not on insulin therapy.

    “However, there are also studies with conflicting data, leading to contrary conclusions, that have shown no or only a short-term benefit (≤ 6 months) of structured BG measurements for people with diabetes not on insulin therapy [6–8].”

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Research works printed but not linked: 3

  1. [8]8. Allen BT, DeLong ER, Feussner JR. Impact of glucose self-monitoring on non-insulin treated patients with type 2 diabetes mellitus. Diabetes Care 1990;13:1044-50.
  2. [12]12. Davidson MB, Castellanos M, Kain D, Duran P. The effect of self- monitoring of blood glucose concentrations on glycated haemoglobin levels in diabetic patients not taking insulin. Am J Med 2005;118:422-5.
  3. [15]15. Miles P, Everett J, Murphy J, Kerr D. Comparison of blood or urine testing by patients with newly diagnosed type 2 diabetes: patient survey after randomised crossover trial. BMJ 1997;315:348-9.

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Authors
O’Kane, M. J., Bunting, B., Copeland, M., & Coates, V. E.
Affiliations
  • Altnagelvin Area Hospital (GB)
  • University of Ulster (GB)
Corresponding author
O’Kane, Maurice J
Venue
BMJ
Publisher
BMJ
Published
2008-04-17
Volume
336
Issue
7654
Pages
1174-1177
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
OpenAlex
W2147892221
Cited by
326
References
29
Citations by year
2026: 3 · 2025: 8 · 2024: 5 · 2023: 6 · 2022: 11 · 2021: 21 · 2020: 18 · 2019: 17 · 2018: 14 · 2017: 13 · 2016: 15 · 2015: 16 · 2014: 21 · 2013: 19 · 2012: 27
FWCI
26.85
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
self-monitoring of blood glucose, type 2 diabetes, newly diagnosed diabetes, glycemic control, HbA1c, depression, psychological well-being, hypoglycemia, oral antidiabetic drugs, body mass index, diabetes education, well-being questionnaire
MeSH terms
Adult, Aged, Anxiety, Depressive Disorder, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Male, Middle Aged, Prognosis, Prospective Studies, Blood Glucose Self-Monitoring, Body Mass Index

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