Concern was expressed over a number of issues surrounding the successful use of selfmonitoring,
and recognised that its cost meant that it had to be effectively deployed. It should
only be supported in the context of a provision of a package of care, including structured
education, from a primary or secondary diabetes care team. The initial education should be
provided by a properly trained and skilled professional with understanding of the problems of
The importance of self-monitoring to the effective use of insulin therapy and for those at risk
of hypoglycaemia through leisure or work activities (including driving) on oral medications
was noted. The frequency of monitoring that is useful to someone with diabetes is highly
individual and it is inappropriate to put an artificial restriction on this.
Hyperglycaemic complications were related to exposure to high glucose levels in plasma, and
there were no major studies like the ROSSO and Kaiser studies for urine glucose monitoring.
The evidence that plasma glucose monitoring could be replaced by urine glucose monitoring
was found to be poor.
Although the DiGEM study was published after the evidence cut-off date, it had been identified
as potentially important on the basis of earlier information.