This publication assesses the association between self-monitoring of blood glucose (SMBG) and blood sugar control in 31,438 people living with diabetes over a 4 year period.

This large study was the first to assess the effects of changing SMBG practice on blood sugar control over a longer period and to separately evaluate new and ongoing SMBG users. The authors observed a significantly different effect between new and ongoing users (suggesting that pooling the two may have biased previous analyses).

Among new users, SMBG was associated with a graded improvement in blood sugar control, even amongst those not treated with drugs. Among established users, there was a significant association between change in SMBG and HbA1c in those treated with drugs; decreases in SMBG frequency were associated with a modest worsening in blood sugar control, whereas increases in SMBG frequency were associated with modest improvements in control.

The similar finding of effect in the meta-analyses of existing randomised trials and this observational study is compelling enough evidence to warrant support of SMBG for motivated patients who are appropriately educated in its use.

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