Commentary

Clinicians who care for patients with chronic diseases are often faced with patients' lack of adherence to treatment recommendations. Many treatment regimens are complex and require adherence for long periods (eg, lifestyle modification). In general, isolated methods to improve adherence have been ineffective.¹ Multidimensional strategies that promote and support patient self management are potentially more efficacious than one dimensional strategies. The assumption behind these strategies is that patient self management leads to improved and sustained patient outcomes.

Self monitoring allows patients with diabetes to make treatment decisions and evaluate their effect on glucose control with the support of a healthcare team. Patients who practice self monitoring become empowered to adjust their diet, exercise, and medications when they receive real time information from glucose monitors and test strips. In type 1 diabetes, glucose self monitoring is critical in guiding medication adjustments in multiple dose insulin programmes.

The review by Coster et al found that self monitoring in type 2 diabetes was ineffective in reducing glycated haemoglobin concentrations. Most of the studies included in this review tested self monitoring as the only or primary adherence improvement strategy. Thus, the best available evidence suggests that glucose self monitoring without a self management support programme is ineffective in reducing glycated haemoglobin concentrations.

Clinics that support a self management approach design the resources within their healthcare system and community to help patients to achieve their goals. Patients learn to use test values to evaluate their efforts. Patients who are unsuccessful with self management can find help from their family, social workers, educators, dietitians, nurses, and physicians. In this context, values obtained from test strips and monitors have meaning, and self monitoring may be effective.²