2 DM have demonstrated the clinical effectiveness of using GHb estimations to monitor blood glucose control. Data from the DCCT suggest that the overall package of intervention employed would have acceptable cost-effectiveness. Standardisation of GHb assays between and within laboratories is an important objective being addressed by current work. Near-patient testing for GHb is being developed, but it is too early to judge its value. Fructosamine estimations, which measure glycaemic control over shorter intervals than GHb, may be useful in diabetic pregnancy, but have not been shown to be better than GHb at this time.
Fructosamine assays are less costly than GHb.
Conclusions A standard protocol should be drawn up for conducting and reporting evaluations of blood glucose monitoring devices. Blood glucose self-monitoring is well established in clinical practice but the optimal use of the technique has not been established. Present evidence suggests that it may not be essential for all patients. Observational studies should be carried out in samples of subjects with type 1 DM to identify groups of patients in whom blood glucose self-monitoring is of benefit and groups in whom it is not. Studies should include not just assessment of GHb, but also the occurrence of hypoglycaemia, patients satisfaction with care and health-related quality of life.