The Endocrine Society of Australia
Recommendations from the Endocrine Society of Australia on thyroid tests, testosterone therapy, insulin sensitivity tests & blood glucose self-monitoring. The Endocrine Society of Australia (ESA) is a national non-profit organisation of scientists and clinicians who conduct research and practice in the field of Endocrinology. The society was founded in 1958 and incorporated in 1986 in the State of Victoria.
4.
Avoid multiple daily glucose self-monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycaemia.
Once target control is achieved in adults with stable type 2 diabetes and the results of self-glucose monitoring become quite predictable, there is little gained in most individuals from repeatedly confirming. There are many exceptions, such as for acute illness, when new medications are added, when weight fluctuates significantly, when A1c targets drift off course and in individuals who need monitoring to maintain targets. Self-monitoring is beneficial as long as one is learning and adjusting therapy based on the result of the monitoring.
Supporting evidence
- Welschen LMC. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database of Systematic Reviews 2012; Issue 1.
- Farmer AJ. Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. British Medical Journal 2012;344:e486.
- Department of Health and Ageing and University of South Australia 2012, Pharmaceutical Benefits Scheme Products Used in the Treatment of Diabetes, Part 1: Blood Glucose Test Strips.
- Clar C. Self-monitoring of blood glucose in type 2 diabetes: systematic review. Health Technology Assessment. 2010;14(12):1-140.
- McIntosh B. Efficacy of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin: a systematic review and meta-analysis. Open Medicine 2010;4(2):e102-13.
- International Diabetes Federation 2009, Guideline: Self-Monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes.
- Allemann S. Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis. Current Medical Research & Opinion. 2009;25(12):2903-13.
How this list was made
The Medical Affairs sub-committee of the Endocrine Society of Australia (ESA) collaborated with the Royal Australasian College of Physicians (RACP) to compile a list of 44 possible low-value interventions using desktop research.
The list was examined and refined down to 8 interventions: comprising 6 that were deemed sufficiently common or important to warrant consideration and two additional practices identified by the committee. A review of the evidence for these 8 was completed and circulated to the whole ESA membership for feedback via an on-line survey. Based on the results of the survey, which attracted 146 respondents, a top 5 was identified.
- 1 Don’t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland.
- 2 Don’t prescribe testosterone therapy unless there is evidence of proven testosterone deficiency.
- 3 Do not measure insulin concentration in the fasting state or during an oral glucose tolerance test to assess insulin sensitivity.
- 4 Avoid multiple daily glucose self-monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycaemia.
- 5 Don’t order a total or free T3 level when assessing thyroxine dose in hypothyroid patients.