[Benefits of blood glucose self-monitoring in the management of insulin-dependent (IDDM) and non-insulin-dependent diabetes (NIDDM). Analysis of the literature: mixed results].

Since the 1980s, self-monitoring of blood glucose (SMBG) has allowed easier and improved treatment of insulin-dependent diabetes mellitus (IDDM). SMBG has proved efficient in very selected patients and in conditions such as pregnancy, intensive insulin therapy (CSII and optimal bolus regimen), physical exercise and self-awareness of specific hypoglycaemic symptoms. Through the use of pen insulin injectors, SMBG should improve the autonomy, well-being and metabolic control of most IDDM patients. However, as SMBG is continuing to develop in France, costs are rising (estimated at $170 million per year in 1997), which has led some diabetologists to question its real benefit for all diabetic patients and its cost-effectiveness. Our study of published data indicates that SMBG often fails to be beneficial in non-selected IDDM patients, whether children adolescents or adults. However, educational sessions on SMBG and insulin dose adjustment have demonstrated that SMBG improves well-trained patients. Most authors recommend applying psychosocial scales and suitable educational tools to obtain positive results and justify the human and economic costs involved. In non-insulin-dependent diabetes mellitus (NIDDM), the use of SMBG is increasingly recommended by diabetologists and general practitioners. However, trials investigating the effects of SMBG in NIDDM patients have found no benefit for metabolic control or weight loss. We recommend a moderate use of SMBG in NIDDM patients and the development of clinical research strategies to study the benefit for NIDDM patients of a method which is increasing health costs appreciably.