Reading Part B

Part B : Multiple Choice Questions Time Limit: 20~25 Minutes

To test or not to test? Self-monitoring of blood glucose in patients with type 2

diabetes

Authors: Sonia Butalia, Doreen M Rabi

Source: Open Medicine

Paragraph 1
There have been considerable advances in the technology of assessing real-time
glucose levels in patients with diabetes. The first self-testing kit for measuring
glucose in urine was developed in the 1940s. The advent of the capillary blood test
strip followed in 1956, and glucose meters in the 1970s and early 1980s. The
introduction of these latter devices meant that patients taking insulin had an option
other than urine testing for monitoring their glucose levels. Since then, glucose meters
have become smaller and lighter, and the amount of blood required and time to get a
result have decreased.

Paragraph 2
These advances have facilitated the adoption of self-monitoring of blood glucose
levels as part of the routine care of diabetes managed with insulin. People with
diabetes can obtain a quick and accurate reading of their blood glucose level and use
this information to adjust their insulin to reach evidence-based therapeutic targets.
Although blood glucose readings inform care providers on the effectiveness of
prescribed treatment regimens, the direct benefit of self-monitoring to the patient not
taking insulin is uncertain.

Paragraph 3
In a recent study, McIntosh and colleagues examined the efficacy of self-monitoring
of blood glucose levels in patients who manage their type 2 diabetes condition
without insulin. Their rigorously conducted systematic review and meta-analysis of
21 studies showed that self-monitoring resulted in a modest, significant reduction in
hemoglobin A concentration compared with no self-monitoring. Data from the study
showed no significant difference between the results from randomized controlled
trials (RCTs) that provided patients with education on how to interpret and apply self-
monitoring test results compared with RCTs that did not.

Paragraph 4
The review by McIntosh and colleagues also demonstrates that self-monitoring of
blood glucose levels results in a reduction in HbA1c concentration of 0.25%. Although
a statistically significant result, it is unclear what it means clinically. A wealth of
epidemiologic evidence has shown significant reductions in micro- and macrovascular
complication rates with decreasing HbA1c levels, with some showing a risk reduction
of up to 18% in cardiovascular events with every 1% decrease in HbA1c level.
However, the number of events prevented by lowering the HbA1c concentration by
0.25% would appear to be quite small given the cost of self-monitoring of blood
glucose.

This resource was developed by OET Online and is subject to copyright ©

Website: http://oetonline.com.au Email: steve@oetonline.com.au
 Reading Part B

Paragraph 5
What is needed is clear evidence on the optimal clinical application of self-
monitoring. Patients with type 2 diabetes are a clinically heterogeneous population.
Although the benefit of self-monitoring to the entire population is small, there are
likely subgroups who do benefit from testing. We must also consider that self-
monitoring of blood glucose is not cheap and has been found to be cost-inefficient.
Despite the paucity of strong evidence for clinical or cost effectiveness, a recent study
by Gomes and colleagues showed that overall use of self-monitoring increased by
almost 250% from 1997 to 2000.

Paragraph 6
Recognizing the tremendous cost of self-monitoring, Gomes and colleagues used
decision analysis modelling to propose several blood glucose self-monitoring
strategies based on the type of therapy patients were receiving such as lifestyle
modification, oral hypoglycemic therapy and insulin. They concluded that unlimited
coverage of self-monitoring for those taking insulin and limited, strategic testing
among those not taking insulin would significantly reduce the costs associated with
delivering self-monitoring on a broad scale and may not alter clinical outcome.

Paragraph 7
So where does that leave us? Self-monitoring of blood glucose appears to improve
glycemic control in patients with type 2 diabetes managed without insulin. But does
this translate into better patient outcomes, especially when we factor in the pain,
inconvenience and cost of self-monitoring to patients? Do all patients with type 2
diabetes managed without insulin need to engage in self-monitoring? Probably not,
but we still lack important information on how to use this technology effectively and
efficiently and who will benefit the most. Ultimately we require prospective trials that
examine under what conditions to make best use of this tool so that a broad,
indiscriminate approach can be avoided.

This resource was developed by OET Online and is subject to copyright ©

Website: http://oetonline.com.au Email: steve@oetonline.com.au
 Reading Part B

Part B : Multiple Choice Questions

1. The main idea presented in paragraph 1 is….

a. The different methods of monitoring blood glucose levels
b. The improvements made in monitoring blood glucose levels
c. The early history of monitoring blood glucose levels
d. The technological advances in treating diabetes

2. Regarding the history of monitoring diabetes, which of the following is

false in paragraph 1?
a. Glucose levels were originally measured in urine
b. Glucose meters were followed by the capillary blood test strip
c. There were less options available for testing diabetes before the 1970s
d. Modern glucose meters are more convenient

3. In paragraph 2, which of the following does not match the information on

monitoring blood glucose levels?
a. For insulin dependent diabetic patients, self monitoring of blood
glucose levels is common nowadays
b. Current technology allows for fast and precise blood glucose level
readings in many diabetic patients
c. Blood glucose level readings are used to regulate insulin dosage
d. The advantages self monitoring brings to the patient is clear

4. According to paragraph 3 which of the following statements is most

accurate regarding the research by McIntosh and colleagues?
a. Self-monitoring did not help lower hemoglobin A
b. The researchers were not satisfied with the results of the study
c. The results of the study were inconclusive
d. Education on how read and use the results did not make a major impact

5. The statistics provided in paragraph 4 indicate that……

a. Self monitoring of blood glucose can reduce HbA1c levels by as much
as 25%
b. A 1% reduction in HbA1c levels can significantly reduce cardiovascular
events
c. The cost of monitoring blood glucose has risen 0.25%
d. The health benefits resulting from self monitoring of blood glucose
levels are significant

6. According to paragraph 5, which of the following statements is false

regarding research into self monitoring
a. In clinical terms, type 2 diabetic patients are varied
b. Not all type 2 diabetic patients benefit from self monitoring
c. Some studies argue that self monitoring can be cost effective
d. Some studies report that the use self-monitoring is greater than ever

This resource was developed by OET Online and is subject to copyright ©

Website: http://oetonline.com.au Email: steve@oetonline.com.au
 Reading Part B

7. In paragraph 6, we can infer from the studies by Gomes and colleagues

that….
a. Self-monitoring is most beneficial for patient’s taking insulin
b. The cost of self-monitoring should be reduced
c. Treatment such as lifestyle modification and oral hypoglycemic
therapy have greater benefits than self-monitoring
d. A reduction in self monitoring could impact on clinical outcomes

8. In paragraph 7, the writers conclude that…..

a. Self monitoring is painful, inconvenient and expensive for patients
b. Overall, the benefits of self-monitoring outweigh the disadvantages
c. Self-monitoring of diabetes is not necessary for all patients
d. None of the above

This resource was developed by OET Online and is subject to copyright ©

Website: http://oetonline.com.au Email: steve@oetonline.com.au
 Reading Part B

Answer  Key    
1.  b  2.  b  3.  d  4.  d  5.  b  6.  c  7.a  8.  c    
Question  1  
a) Incorrect:  although  different  methods  are  mentioned,  it  is  not  the  main  idea  
b) Correct:    Refer  topic  sentence  
c) Incorrect:  No,  both  early  history  and  current  time  are  mentioned  
d) Incorrect:  No,  monitoring,  not  treating  
Question  2  
a) Incorrect:  True  
b) Correct:  Not  were  followed  by,  followed  
c) Incorrect:  True  
d) Incorrect:  True  
Question  3  
a) Incorrect:  True:  (synonym  routine=common)  
b) Incorrect:  True  (synonyms:  quick  and  accurate  =  fast  and  precise)  
c) Incorrect:  True,  (synonym:  adjust=regulate)  
d) Correct:  Opposite  is  true  not  clear,  uncertain  
Question  4  
a) Incorrect:  Opposite  is  true  
b) Incorrect:  Not  mentioned  
c) Incorrect  :  Not  mentioned  
d) Correct:  Matches,  refer  highlight  
Question  5  
a) Incorrect:  ,  0.25  not.25%  
b) Correct:  See  highlight  
c) Incorrect:  Not  mentioned  
d) Incorrect:    No,  number  of  events  prevented  appears  to  be  low  
Question  6  
a) Incorrect:  True:  heterogeneous=dissimilar  
b) Incorrect:  True:  benefit  is  small  
c) Correct:  false  
d) Incorrect:  true  greater  than  ever=increase  of  250%  
Question  7  
a) Correct:  see  highight    
b) incorrect:  not  cost  of  self  monitoring,  costs  associated  with  self  monitoring  
c) Incorrect:  not  mentioned  
d) Incorrect:  opposite  is  true  
Question  8  
a) Incorrect:  may  be  true,  but  not  the  main  point  
b) Incorrect:  not  mentioned,  and  opposite  is  probably  true  
c) Correct:  Best  summary  
d) Incorrect  
   
 

This resource was developed by OET Online and is subject to copyright ©

Website: http://oetonline.com.au Email: steve@oetonline.com.au
 Reading Part B

To test or not to test? Self-monitoring of blood glucose in patients with type 2

diabetes managed without insulin

Authors: Sonia Butalia, Doreen M Rabi

Source: Open Medicine

Paragraph 1
(1)There have been considerable advances in the technology of assessing real-time
glucose levels in patients with diabetes. The first self-testing kit for measuring
glucose in urine was developed in the 1940s. (2)The advent of the capillary blood test
strip followed in 1956, and glucose meters in the 1970s and early 1980s. The
introduction of these latter devices meant that patients taking insulin had an option
other than urine testing for monitoring their glucose levels. Since then, glucose meters
have become smaller and lighter, and the amount of blood required and time to get a
result have decreased.

Paragraph 2
These advances have facilitated the adoption of self-monitoring of blood glucose
levels as part of the routine care of diabetes managed with insulin. People with
diabetes can obtain a quick and accurate reading of their blood glucose level and use
this information to adjust their insulin to reach evidence-based therapeutic targets.
Although blood glucose readings inform care providers on the effectiveness of
prescribed treatment regimens, (3) the direct benefit of self-monitoring to the patient
not taking insulin is uncertain.

Paragraph 3

In a recent study, McIntosh and colleagues examined the efficacy of self-monitoring

of blood glucose levels in patients who manage their type 2 diabetes condition
without insulin. Their rigorously conducted systematic review and meta-analysis of
21 studies showed that self-monitoring resulted in a modest, significant reduction in
hemoglobin A concentration compared with no self-monitoring. Data from the study
showed (4)no significant difference between the results from randomized controlled
trials (RCTs) that provided patients with education on how to interpret and apply self-
monitoring test results compared with RCTs that did not.

Paragraph 4

The review by McIntosh and colleagues also demonstrates that self-monitoring of

blood glucose levels results in a reduction in HbA1c concentration of 0.25%. Although
a statistically significant result, it is unclear what it means clinically. A wealth of
epidemiologic evidence has shown significant reductions in micro- and macrovascular
complication rates with decreasing HbA1c levels, with some showing (5) a risk
reduction of up to 18% in cardiovascular events with every 1% decrease in HbA1c
level. However, the number of events prevented by lowering the HbA1c concentration
by 0.25% would appear to be quite small given the cost of self-monitoring of blood
glucose.

This resource was developed by OET Online and is subject to copyright ©

Website: http://oetonline.com.au Email: steve@oetonline.com.au
 Reading Part B

Paragraph 5
What is needed is clear evidence on the optimal clinical application of self-
monitoring. Patients with type 2 diabetes are a clinically heterogeneous population.
Although the benefit of self-monitoring to the entire population is small, there are
likely subgroups who do benefit from testing. We must also consider that self-
monitoring of blood glucose is not cheap and has been found to be cost-inefficient.
Despite the paucity of strong evidence for clinical or cost effectiveness, a recent study
by Gomes and colleagues showed that overall use of self-monitoring increased by
almost 250% from 1997 to 2000.

Paragraph 6
Recognizing the tremendous cost of self-monitoring, Gomes and colleagues used
decision analysis modelling to propose several blood glucose self-monitoring
strategies based on the type of therapy patients were receiving such as lifestyle
modification, oral hypoglycemic therapy and insulin. (7)They concluded that
unlimited coverage of self-monitoring for those taking insulin and limited, strategic
testing among those not taking insulin would significantly reduce the costs associated
with delivering self-monitoring on a broad scale and may not alter clinical outcome.

Paragraph 7

So where does that leave us? Self-monitoring of blood glucose appears to improve
glycemic control in patients with type 2 diabetes managed without insulin. But does
this translate into better patient outcomes, especially when we factor in the pain,
inconvenience and cost of self-monitoring to patients? (8)Do all patients with type 2
diabetes managed without insulin need to engage in self-monitoring? Probably not,
but we still lack important information on how to use this technology effectively and
efficiently and who will benefit the most. Ultimately we require prospective trials that
examine under what conditions to make best use of this tool so that a broad,
indiscriminate approach can be avoided.

This resource was developed by OET Online and is subject to copyright ©

Website: http://oetonline.com.au Email: steve@oetonline.com.au