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Diabetes self-monitoring increases anxiety, depression

18/04/2008

Self-monitoring of blood sugar levels by people with type two diabetes is more likely to make them anxious than to help their health, studies claim today.

A series of articles published on www.bmj.com says self-monitoring is beneficial for patients who have type one diabetes and for people with type two diabetes who use insulin.

But they claim there is a lack of clinical evidence that it helps people with type two diabetes who do not use insulin.

Researchers at the University of Ulster studied 184 people with newly diagnosed type two diabetes.

The participants were split into two groups – self-monitoring or no monitoring – for a year and were followed up at three-monthly intervals.

The study found no significant effect of self-monitoring of blood glucose on glycaemic control but revealed that it may be associated with high levels of depression and anxiety.

Some participants said they found self-monitoring "uncomfortable, intrusive and unpleasant".

"The negative effect [of monitoring] might relate less to feelings of powerlessness in the face of high blood glucose readings than to the enforced discipline of regular monitoring without any tangible gain," the researchers conclude.

A second study released today by researchers at the University of Oxford analysed the cost-effectiveness of helping patients with non-insulin treated type two diabetes self monitor their blood glucose levels in addition to standardised usual care.

"Self-monitoring of blood glucose with or without additional training in incorporating the results into self care was associated with higher costs and lower quality of life in patients with non-insulin treated type two diabetes," the researchers stated.

"In light of this, and no clinically significant differences in other outcomes, self-monitoring of blood glucose is unlikely to be cost effective in addition to standardised usual care."

Commenting on the two studies in an accompanying editorial, Professor Martin Gulliford from King's College London said the £100 million that is spent each year on self-monitoring for non-insulin treated type two diabetes patients "represents a substantial opportunity cost in terms of alternative interventions that might have improved the health of people with diabetes".

These, he says, could include more effective disease control measures aimed not at blood glucose but at blood pressure, cholesterol, smoking, body weight and physical activity.