TY - JOUR T1 - Improving the effectiveness of self-monitoring of blood glucose in type 2 diabetes JF - British Journal of General Practice JO - Br J Gen Pract SP - e211 LP - e212 DO - 10.3399/bjgp15X684277 VL - 65 IS - 633 AU - Tim A Holt Y1 - 2015/04/01 UR - http://bjgp.org/content/65/633/e211.abstract N2 - Around 6 years ago self-monitoring of blood glucose (SMBG) was identified as an area of costly, often inappropriate prescribing by commissioning bodies. Unnecessary prescribing of testing strips appeared easy to identify using simple searches on practice computers. In this issue of the BJGP, Robson et al describe a study of an intervention using a multimodal strategy including guideline development and implementation, education, support of clinicians and patients, and feedback on performance. This was designed to tackle the issue in the Tower Hamlets, and City and Hackney Clinical Commissioning Groups (CCGs), with Newham CCG serving as a control.1 They demonstrate that in this region, the intervention (which promoted case by case review by clinicians as well as computer searches) substantially reduced the prescribing of SMBG strips compared to the control.Both CCG policy and the Robson study were motivated by a lack of evidence supporting SMBG in large numbers of patients with type 2 diabetes not using insulin. Numerous randomised trials have measured potential benefits in this group, particularly improvements in HbA1c and psychological outcomes. Despite a common assumption of 20 years ago that glycaemic control and quality of life would be improved, these trials suggest otherwise. The most recent Cochrane Review reports that for patients with type 2 diabetes not taking insulin there is little, if any, improvement in HbA1c, and no effect on patient satisfaction, general wellbeing or general health-related quality of life.2However, a separate question concerns the ability of self-monitoring to improve safety by reducing risk of hypoglycaemia and its complications, particularly among drivers. This is much more difficult to investigate. Mild hypoglycaemia is more, not less frequently recorded in those who self-monitor, because regular self-monitoring makes the patient more aware of hypoglycaemic episodes.2 More severe events that … ER -