***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A cross-sectional study to assess home glucose monitoring practice s was conducted in 200 non-insulin-treated diabetic patients consecutively attending our hospital clinic . Of the 200 , 97 ( 48 % ) patients ( Group 1 ) regularly monitored urine ( n = 74 ) , blood ( n = 19 ) or both ( n = 4 ) ; 103 ( 52 % ) patients ( Group 2 ) performed no home monitoring . The two groups were similar in terms of age , sex , duration of diabetes and type of treatment . The prevalence of diabetic complications was also closely comparable and only peripheral neuropathy differed between the groups , being more common in Group 1 ( n = 12 ) than Group 2 ( n = 4 ) ; p < 0.05 . There was also no significant difference between the HbA1 concentration ( mean + /- SD ) in Group 1 ( 9.7 + /- 2.2 % ) and Group 2 ( 9.4 + /- 2.0 % ) . The mean frequency of home monitoring  was four tests weekly , but only 21 ( 22 % ) kept a written record and 60 ( 62 % ) would never alter their treatment on the basis of their results . Almost a third of patients could not interpret the results of monitoring or give the normal range of values . Home glucose monitoring , particularly of urine , is widely practised in Type 2 diabetes , at considerable overall expense . However , convincing evidence of its value in helping patients improve their blood glucose control or preventing the complications of the disease is lacking OBJECTIVE To investigate the effect of meal-related self-monitoring of blood glucose on glycemic control and well-being in non-insulin-treated type 2 diabetic patients . RESEARCH DESIGN AND METHODS This 6-month study , which included 6 months of follow-up , adopted a prospect i ve , multicenter , r and omized controlled design . Subjects were r and omized to two groups : one group used a blood glucose-monitoring device , kept a blood glucose/eating diary , and received st and ardized counseling ; the control group received nonst and ardized counseling on diet and lifestyle . The primary efficacy parameter was the change in HbA(1c ) . Secondary efficacy variables included changes in body weight , lipids , and microalbumin and changes in treatment satisfaction and well-being . RESULTS In the per- protocol analysis , the use of a self-monitoring blood glucose device significantly reduced HbA(1c ) levels by 1.0 + /- 1.08 % compared with 0.54 + /- 1.41 % for the control group ( P = 0.0086 ) ; subgroup analysis showed three types of responders . Body weight , total cholesterol , and microalbumin improved when using a glucometer , but there was no statistically significant difference between the two groups . Treatment satisfaction increased in both groups to a similar extent ( P = 0.9 ) . Self-monitoring result ed in a marked improvement of general well-being with significant improvements in the subitems depression ( P = 0.032 ) and lack of well-being ( P = 0.02 ) . CONCLUSIONS Meal-related self-monitoring of blood glucose within a structured counseling program improved glycemic control in the majority of non-insulin-treated type 2 diabetic patients in this study . The finding of three types of responders will be important for future planning of counseling and educational interventions Some features of diabetes care and diabetes treatment regimen which may have an impact on health-related quality of life ( HRQOL ) in people with diabetes were studied cross-sectionally using the SF-20 question naire . Of the 381 subjects with Type 2 diabetes aged under 65 years , 260 ( 68 % ) participated in the study . On univariate analysis , HRQOL was associated with regular clinical review ( check-up at least twice a year ) and continuity of care ( the same GP for at least 2 years ) , education by a diabetes nurse , and satisfaction with diabetes education . No associations were found between the HRQOL dimensions and home glucose monitoring , participation in educational courses , or satisfaction with care . On logistic regression analysis only good continuity of care was significantly associated with the better well-being dimensions of the SF 20 ( ORs 2.5 - 6.0 ) . However , good continuity of care was also associated with less satisfactory glucose control ( HbA(1c ) 8.9 + /- 2.0 ( + /- SD ) vs 8.3 + /- 2.0 % , P=0.04 ) . It is concluded that a permanent physician-patient relationship may improve HRQOL in subjects with Type 2 diabetes , but further prospect i ve studies are needed to confirm this finding Objective To determine whether self monitoring , alone or with instruction in incorporating the results into self care , is more effective than usual care in improving glycaemic control in non-insulin treated patients with type 2 diabetes . Design Three arm , open , parallel group r and omised trial . Setting 48 general practice s in Oxfordshire and South Yorkshire . Participants 453 patients with non-insulin treated type 2 diabetes ( mean age 65.7 years ) for a median duration of three years and a mean haemoglobin A1c level of 7.5 % . Interventions St and ardised usual care with measurements of HbA1c every three months as the control group ( n=152 ) , blood glucose self monitoring with advice for patients to contact their doctor for interpretation of results , in addition to usual care ( n=150 ) , and blood glucose self monitoring with additional training of patients in interpretation and application of the results to enhance motivation and maintain adherence to a healthy lifestyle ( n=151 ) . Main outcome measure HbA1c level measured at 12 months . Results At 12 months the differences in HbA1c level between the three groups ( adjusted for baseline HbA1c level ) were not statistically significant ( P=0.12 ) . The difference in unadjusted mean change in HbA1c level from baseline to 12 months between the control and less intensive self monitoring groups was −0.14 % ( 95 % confidence interval −0.35 % to 0.07 % ) and between the control and more intensive self monitoring groups was −0.17 % ( −0.37 % to 0.03 % ) . Conclusions Evidence is not convincing of an effect of self monitoring blood glucose , with or without instruction in incorporating findings into self care , in improving glycaemic control compared with usual care in reasonably well controlled non-insulin treated patients with type 2 diabetes . Trial registration Current Controlled Trials IS RCT N47464659 The goal of this study was to compare the relative efficacy and cost of self-monitoring of blood glucose ( SMBG ) with routine urine testing in the management of patients with type II ( non-insulin-dependent ) diabetes mellitus not treated with insulin . Fifty-four patients with type II diabetes mellitus , not treated with insulin , who had inadequate glucose control on diet aloneor diet and oral hypoglycemic agents were studied . Patients performed SMBG or urine glucose testing as part of a st and ardized treatment program that also included diet and exercise counseling . During the 6-mo study , both the urine-testing and SMBG groups showed similar improvement in glycemic control ; within each group , there were significant improvements in fasting plasma glucose ( reduction of 1.4 ± 3.2 mM , P < 0.03 ) and glycosylated hemoglobin ( reduction of 2.0 ± 3.4 % , P < 0.01 ) levels . Seventeen ( 31 % ) of54 patients actually normalized their glycosylated hemoglobin values , 9 in the urine-testing group and 8 in the SMBG group . Comparisons between the urine-testing and SMBG groups showed no significant differences in mean fasting plasma glucose ( P > 0.86 ) , glycosylated hemoglobin ( P > 0.95 ) , or weight ( P < 0.19 ) . In patients with type II diabetes mellitus not treated with insulin , SMBG is no more effective , but is 8–12 times more expensive , thanurine testing in facilitating improved glycemic control . Our results do not support widespread use of SMBG in diabetic patients not treated with insulin Background We do not yet know how to use blood glucose self-monitoring ( BGSM ) most effectively in the self-management of type 2 diabetes treated with oral medication . Training in monitoring may be most effective in improving glycaemic control and well being when results are linked to behavioural change . Methods / design DiGEM is a three arm r and omised parallel group trial set in UK general practice s. A total of 450 patients with type 2 diabetes managed with lifestyle or oral glucose lowering medication are included . The trial compares effectiveness of three strategies for monitoring glycaemic control over 12 months ( 1 ) a control group with three monthly HbA1c measurements ; interpreted with nurse-practitioner ; ( 2 ) A self-testing of blood glucose group ; interpreted with nurse- practitioner to inform adjustment of medication in addition to 1 ; ( 3 ) A self-monitoring of blood glucose group with personal use of results to interpret results in relation to lifestyle changes in addition to 1 and 2.The trial has an 80 % power at a 5 % level of significance to detect a difference in change in the primary outcome , HbA1c of 0.5 % between groups , allowing for an attrition rate of 10 % . Secondary outcome measures include health service costs , well-being , and the intervention effect in sub-groups defined by duration of diabetes , current management , health status at baseline and co-morbidity . A mediation analysis will explore the extent to which changes in beliefs about self-management of diabetes between experimental groups leads to changes in outcomes in accordance with the Common Sense Model of illness . The study is open and has recruited more than half the target sample . The trial is expected to report in 2007 . Discussion The DiGEM intervention and trial design address weaknesses of previous research by use of a sample size with power to detect a clinical ly significant change in HbA1c , recruitment from a well-characterised primary care population , definition of feasible monitoring and behaviour change strategies based on psychological theory and evidence , and measures along the hypothesised causal path from cognitions to behaviours and disease and well being related outcomes . The trial will provide evidence to support , focus or discourage use of specific BGSM strategies A diabetes protocol characterized by self-monitoring of blood glucose was introduced in four general practice s with the aim of making the frequency of consultations dependent on the metabolic regulation and emphasizing body weight reduction . The feasibility of the programme was investigated and the results after 1 year were compared with those of conventional care in four control practice s. In the experimental practice s , 13 patients switched from a medical specialist 's to a general practitioner 's supervision  , 20 remained under supervision of their GP  and 33 started self-monitoring .  The self-monitoring rate , the consultation frequency according to protocol , the low number of dropouts and inadequate referrals and adherence to the therapeutic scheme showed that the protocol was feasible for both the GPs and the patients . At the initial assessment , the regulation of the diabetes was worse in patients of the experimental group , compared with those of the control group ( mean HbA1 9.7 % vs 8.9 % ; p less than 0.05 ) . On average , patients in the experimental group ( n = 56 ) lost 0.4 kg of body weight , whereas those in the control group ( n = 73 ) gained 0.1 kg ( n.s . ) . The mean change in HbA1 , adjusted for the initial value , was -0.4 % in the experimental and + 0.5 % in the control group ( p less than 0.05 ) . The results of the protocol can be attributed to a combination of greater participation of the patient , the individualized consultation frequency and the prescription of oral hypoglycaemic agents according to body weight development OBJECTIVE Recent Veterans Affairs ( VA ) guidelines recommend that persons with stable type 2 diabetes controlled on oral agents or diet therapy perform self-monitoring of blood glucose ( SMBG ) twice weekly . We assessed the impact of a modification of these guidelines on hemoglobin A1c ( HbA1c ) and monitoring cost . STUDY DESIGN Retrospective , noncrossover clinical trial . PATIENTS AND METHODS We instructed persons with type 2 diabetes to perform SMBG testing according to modified adapted VA guidelines . We compared patients ' baseline average testing frequency and HbA1c with those obtained during a 6-month interval beginning 2 months after implementation of the modified guidelines . The impact on the cost of monitoring was calculated . RESULTS At baseline , 913 of 1,213 SMBG users with diabetes on oral hypoglycemic agents had HbA1c tested ( HbA1c = 7.83 % + /- 1.34 % ) ; their frequency of SMBG was 1.36 + /- 0.95 strips per patient per day . Postimplementation , 974 of 1,278 persons with diabetes had HbA1c tested ( HbA1c = 7.86 % + /- 1.54 % ; P= .63 vs baseline ) ; frequency of SMBG decreased by 46 % to 0.74 + /- 0.50 strips per patient per day ( P < .0001 ) . At baseline , 154 of 254 SMBG users with diabetes on diet therapy had 
    Output:
    
Evidence from the cross-sectional and longitudinal studies was inconclusive .
Evidence from r and omized controlled trials suggests that SMBG may lead to improvements in glucose control .
CONCLUSIONS SMBG may be effective in controlling blood glucose for patients with type 2 diabetes .
There is a need for studies that implement all the components of the process for self-regulation of SMBG to assess whether patient use of SMBG will improve HbA1c levels