Is Glucose Self-Monitoring Worthwhile in Non–Insulin-Treated Diabetes?

Summary and Comment |
June 29, 2017

Is Glucose Self-Monitoring Worthwhile in Non–Insulin-Treated Diabetes?

  1. Bruce Soloway, MD

In a study with limitations, self-monitoring did not improve outcomes.

  1. Bruce Soloway, MD

Most non–insulin-treated patients with type 2 diabetes perform self-monitoring of blood glucose (SMBG), but whether this practice improves glycemic control or quality of life is unclear. Researchers in North Carolina randomized 450 non–insulin-treated type 2 diabetics (glycosylated hemoglobin [HbA1c] level, 6.5%−9.5% within 6 months preceding randomization) to no SMBG, once-daily SMBG, or once-daily SMBG plus automated algorithm-derived messages designed to educate and motivate patients. Primary care providers received reports of SMBG data and continued routine management of their patients' diabetes. HbA1c and health-related quality of life were measured at baseline and 1 year later. Otherwise, the study team did not contact the patients or clinicians; interim HbA1c values were retrieved from patients' electronic medical records.

Among patients randomized to SMBG, adherence to daily testing decreased from about 90% at baseline to about 55% at 1 year, with less-frequent testing in patients who received automated messages than in those who did not. Mean HbA1c was significantly lower in both SMBG groups than in the no-SMBG group (mean difference, −0.33%) at 6 months. However, at 1 year, groups did not differ significantly in HbA1c levels or health-related quality of life.

Comment

Without consistent reinforcement, adherence to SMBG eroded rapidly; the authors suggest that this might have contributed to the disappearance of SMBG's early effect on HbA1c. In my experience, SMBG can be helpful for some non−insulin-treated patients, by providing daily reinforcement of lifestyle choices that enhance glycemic control. More rigorous studies could help us identify those patients with type 2 diabetes for whom SMBG might add measurable value.

Editor Disclosures at Time of Publication

  • Disclosures for Bruce Soloway, MD at time of publication Nothing to disclose

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