***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: 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 Prospect i ve r and omised 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 r and omised 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 HbA1c , psychological indices , use of oral hypoglycaemic drugs , body mass index ( BMI ) , and reported hypoglycaemia rates . Results 96 patients ( 55 men ) were r and omised 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 HbA1c ( 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 HbA1c ( 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 question naire ( 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 IS RCT N 49814766 AIM To determine if therapeutic management programmes for type 2 diabetes that include self-monitoring of blood glucose ( SMBG ) result in greater reductions in glycated haemoglobin ( HbA1c ) compared with programmes without SMBG in non-insulin requiring patients . METHODS Multicentre , r and omized , parallel-group trial . A total of 610 patients were r and omized to SMBG or non-SMBG groups . Patients in both groups received the same oral antidiabetic therapy using a gliclazide modified release (MR)-based regimen for 27 weeks . The primary efficacy end-point was the difference between groups in HbA1c at the end of observation . RESULTS A total of 610 patients were r and omized : 311 to the SMBG group and 299 to the non-SMBG group .  HbA1c decreased from 8.12 to 6.95 % in the SMBG group and from 8.12 to 7.20 % in the non-SMBG group ; between-group difference was 0.25 % ( 95 % CI : 0.06 , 1.03 ; p = 0.0097 ) . Symptoms suggestive of mild to moderate hypoglycaemia was the most commonly reported adverse event , reported by 27 ( 8.7 % ) and 21 ( 7.0 % ) patients in the SMBG and non-SMBG groups , respectively ; the incidence of symptomatic hypoglycaemia was lower in the SMBG group . CONCLUSION In patients with type 2 diabetes , the application of SMBG as an adjunct to oral antidiabetic agent therapy results in further reductions in HbA1c 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 AIMS To investigate whether availability of glucometer reagents increases the frequency of self-blood glucose monitoring ( SBGM ) and improves glycaemic control in diabetic patients . METHODS Sixty-two insulin-treated diabetic patients were r and omized to two groups , matched for age , gender , education , income , type and duration of diabetes , years of insulin treatment , number of daily insulin injections , and haemoglobin (Hb)A1c . All patients were given a glucometer , but one group ( no cost , NC ) was provided glucometer test strips free of charge . The other group ( control , C ) had to purchase strips as they found it necessary . Both groups of patients were followed longitudinally at 2-monthly intervals for 12 months with measurement of blood glucose and HbA1c , and the frequency of SBGM was determined by downloading the glucometer memory . RESULTS The SBGM frequency was significantly higher in the NC group vs. the C group during the first 4 months ( 2.0 + /- 0.2 tests/day vs. 1.4 + /- 0.1 tests/day , P<0.025 ) . Mean HbA1c remained stable over the 12 months in the NC group , whereas an increase with time was observed in the C group . The difference in HbA1c between the two groups was significant ( P<0.002 ) after 6 months . R and om blood glucose measured at each visit and average glucose recorded by the glucometer were also lower in the NC group vs. the C group ( P<0.005 ) . There was a negative correlation between HbA1c and SBGM frequency , and HbA1c in patients testing at least twice a day was lower than in those testing less than twice a day ( 8.8 + /- 0.2 % vs. 9.6 + /- 0.2 % , P<0.001 ) . CONCLUSIONS In this prospect i ve study , having easy access to glucometer strips provided free of charge to patients increased SBGM frequency . The relationship between HbA1c and SBGM frequency supports the view that SBGM is an essential tool in diabetes management 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 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 To assess the cost effectiveness of self monitoring of blood glucose alone or with additional training in incorporating the results into self care , in addition to st and ardised usual care for patients with non-insulin treated type 2 diabetes . Design Incremental cost utility analysis from a healthcare perspective . Data on re source use from the r and omised controlled diabetes glycaemic education and monitoring ( DiGEM ) trial covered 12 months before baseline and 12 months of trial follow-up . Quality of life was measured at baseline and 12 months using the EuroQol EQ-5D question naire . Setting Primary care in the United Kingdom . Participants 453 patients with non-insulin treated type 2 diabetes .  Interventions St and ardised usual care ( control ) compared with additional self monitoring of blood glucose alone ( less intensive self monitoring ) or with training in self interpretation of the results ( more intensive self monitoring ) . Main outcome measures Quality adjusted life years and healthcare costs ( sterling in 2005 - 6 prices ) . Results The average costs of intervention were £ 89 ( € 113 ; $ 179 ) for st and ardised usual care , £ 181 for less intensive self monitoring , and £ 173 for more intensive self monitoring , showing an additional cost per patient of £ 92 ( 95 % confidence interval £ 80 to £ 103 ) in the less intensive group and £ 84 ( £ 73 to £ 96 ) in the more intensive group . No other significant cost difference was detected between the groups . An initial negative impact of self monitoring on quality of life occurred , averaging −0.027 ( 95 % confidence interval−0.069 to 0.015 ) for the less intensive self monitoring group and −0.075 ( −0.119 to −0.031 ) for the more intensive group . Conclusions 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 2 diabetes . In light of this , and no clinical ly significant differences in other outcomes , self monitoring of blood glucose is unlikely to be cost effective in addition to st and ardised usual care . Trial registration Current Controlled Trials IS RCT N47 
    Output:
    
Subgroup analysis indicated that results from RCTs that provided patients with education on how to interpret and apply self-monitoring test results were similar to those from RCTs that did not .
On the basis of limited evidence , self-monitoring of blood glucose levels did not demonstrate consistent benefits in terms of quality of life , patient satisfaction , prevention of hypoglycemia or long-term complications of diabetes , or reduction of mortality .
There was insufficient evidence pertaining to the optimal frequency of self-monitoring .
Interpretation Self-monitoring of blood glucose levels was associated with a modest , statistically significant reduction in hemoglobin A1c concentrations , regardless of whether patients were provided with education on how to interpret and use the test results .