- In patients with diabetes who don’t require insulin, self-monitoring of blood glucose had a modest effect on HbA1c levels at six-months, which subsided after 12 months. - Self-monitoring of blood glucose in non-insulin treated diabetics had no effect on satisfaction, general well-being or general health-related quality of life. - Supplies required for self-monitoring of blood glucose are more expensive than for urine testing, a common alternative for non-insulin treated diabetics.
By Christen Brownlee, Contributing Writer Research Source: The Cochrane Library Health Behavior News Service (HBNS)
For type 2 diabetics who are not on insulin, monitoring their blood sugar does little to control blood sugar levels over time and may not be worth the effort or expense, according to a new evidence review.
Self-monitoring blood sugar levels for type 1 diabetics and type 2 diabetics who require insulin is recognized as a critical part of self-care. For these insulin taking diabetics, keeping track of blood sugar levels helps them attempt to keep glucose levels within an acceptable range. However, it has been unclear if self-monitoring of blood sugar has the same value for type 2 diabetics who are not on insulin.
To answer this question, Uriëll L. Malanda of the VU University Medical Center in Amsterdam and his colleagues reviewed 12 studies, of more than 3,000 non-insulin-using diabetics. The review showed that self-monitoring of blood sugar by these patients had only a modest effect on a measure called HbA1c, a standard for assessing blood glucose control. Over a six-month period, patients who tested their own blood glucose levels reduced HbA1c by about 0.3 percent. This effect nearly completely dissipated after 12 months.
Additionally, the review showed that blood sugar self-monitoring had no effect on patients’ satisfaction, general well being, or general health-related quality of life. One study, which compared the cost of the first year of monitoring blood for glucose versus urine testing, found that monitoring blood glucose was 12 times more expensive.
The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collection, an international organization that evaluates medical research.
Mayer Davidson, M.D., a professor of medicine at Charles Drew University in Los Angeles who authored one of the studies included in the review, notes that many endocrinologists recommend blood glucose self-monitoring as part of efforts to educate patients on the effect of lifestyle habits—for example, how eating an apple affects their blood glucose compared to drinking a glass of apple juice. However, knowing their blood sugar numbers doesn’t appear to change patients’ behavior.
“Patients aren’t using these numbers to do anything clinically significant,” he says.
With the cost of blood glucose test strips for home monitoring equipment hovering around 1 dollar apiece, he adds, there doesn’t appear to be enough “bang for the buck” to recommend that form of self-monitoring for most patients.
Authors of the review agree. “Regular self-monitoring of blood glucose in non-insulin treated patients has minimal impact on glycemic control, has no impact on general well-being or quality of life, and is rather expensive. Consequently, it does not add to a clinically relevant long-term benefit,” Malanda says.
There are T2 members who will be weighing to strongly disagree with these findings. They've done remarkably as a result of frequent testing to keep BG within wonderful range. With testing, they've learned how food & what food effects them, the benefits of exercise in helping to control BG & if oral meds are intend assiting or not. Judith has a consistently stellar A1c without meds, or insulin.
Then there's the issue of many T1s who are misdiagnosed as T2 based on age &/or weight. Without regular self-monitoring of BG, they may have never received the correct diagnosis & treatment, or received it far too late.
We all know that depending on A1c's only tells a small part of the diabetic picture.
Head in sand to save insurance bucks on test strips is a short-sighted approach that results in compromised health.
I would like to see a study that correlates the effect of BG monitoring to the level of instruction/coaching received by the person with diabetes.
Based on the many "I don't know what to do" postings I see here, I'm pretty sure there are a lot of people out there that don't know what to do with the information that they get from monitoring their BG.
Data is just data. It's what you do because of the data that counts.
That's a good point, Corinna. I had a strong negative reaction to this article, but Gerri responded before me and said it all in a very measured manner. But it's true that lack of understanding of what the numbers mean, and more importantly what to do about them, makes testing significantly less useful than it can be. I would add that I think information of how to use the numbers can come from a number of different sources such as doctor, cde, endo, but also from books such as Blood Sugar 101, from the DOC and from shows such as dLife.
But bottom line if we keep having medical personnel telling newly diagnosed type 2 diabetics, "you only have to test once a day" and "you can eat anything you want" and "as long as you stay under 180 you will be fine", it's an uphill battle.
Well, given that the standard education tells you to test for no apparent reason, this sort of study could have been predicted. In fact, you could do a study suggesting that injecting insulin into your shoe leads to no blood sugar improvement.
It is shocking that after all these years, diabetes education curriculum still does not tell people to do anything with their readings (except to report them to your doctor). I still shake my head. I mean why couldn't they simply tell people to test, and if their blood sugar is too high, then cut back on the carbs.
More evidence of the poor state of standard T2 treatment. Ideally strips and ones blood sugar should form a feedback loop. If a meal spikes you, you need to change the composition of the meal. You also get positive feedback when things like exercise and good meal choices have a positive effect on your numbers. I would bet most tuD T2's, who have successfully gotten their blood sugar under control, did it just this way. I'd be curious how many have done it with one strip a day?
Hard to say what percentage would actually use the data, but you'll never know if you don't instruct patients how to do it.
I can manage with one strip a day now because I did a lot of experimentation and used a lot of strips for the first year after I was diagnosed. If I have to deviate from my standard fare, though, I'll test throughout the day to be sure things are okay. The ongoing idiocy about diabetes, mostly from people in the medical profession, appalls me. I have T2 relatives who have died because they were never educated about their disease and did not take the initiative to find out for themselves. I'm going to go bang my head on my desk for a while now.
I left them a comment. I'll probably never be invited to the party.
"What continues to shock me about these sorts of studies is that SMBG was never about taking tests and not doing anything with the results, it was always about acting on the result. Dr. Richard Bernstein first bought a blood glucose meter after seeing an advertisement in Oct 1969 and promptly discovered that the foods that he ate affected his blood sugar (duh). He started adjusting his diet to reduce the surges in his blood sugar. His primary observation, carbs raise blood sugar (double duh). And so we sit here, more than fourty years later. The ADA and medical establishment entrenched. What do patients get taught from this fundamental observation made all that long time ago? Test your blood sugar, then ignore it and eat a high carb diet. This study while done to a rigorous methodology is truly an example of garbage in garbage out. It is high time that patients get taught that they need to "Eat to their Meter." I call on the ADA, the AADE and other organizations establishing education criteria to climb out of their rut and start teaching a responsible curriculum. "
Great post FROM all who have commented! I am almost in tears because now there will probably be an official edict from insurance companies to limit blood testing supplies for non-insulin taking type 2 diabetics. More on the general "Miseducation of the Type 2 :These are the friends and co-workers who tell me " My doctor did not tell me to test more than once a day. I am doing just fine." They do not know what their A1C is , nor what it means;nor what to do with it nor the blood glucose testing information. The more "compliant" ones just write it in a daily log book ( "For the doctor to look at.", They say.)
One of my good friends has been told that she is a "pre-diabetic" with an a1c of 7.5..She is not on meds nor insulin and despite nudges from me to test her blood sugars both before AND aftet we eat, she has declined. She has a meter and strips, extras donated to her by her sister who is diabetic, and from me. She says " My doctor did not tell me to do that, I not have the bad diabetes ( type One) like you." She has relatives wh have have suffered from complications of Type 2, but her doctor ( a GP) keeps telling her not to be concerned about testing, to keep doing what she is doing.. She has lost weight through exercise,low- fat, cutting carbs ( not but one slices of bread per meal insstead of two and a full sugary desert); and is to be commended for her efforts. A1c has NOT changed though. She tells me she is "Not diabetic, but pre-diabetic"..
Again, This is the VERY common state of Type 2 miseducation. If the insurance companies use this study to support the ancient, non-effectual test paradigms..I do not know what to say!! I hope that many more type 2's will question this trend and try to get more information..But what do you do when you DO NOT KNOW THAT YOU DO N0T KNOW?y
I left a message at the site, too, trying to explain what "eat to your meter" is. But the study is published, and who's going to listen to a bunch of dumb diabetics? One of the reasons I'm glad I'm on insulin is that I'm in control, not a dumb doc who has a prescription pad in his hand and a bunch of educated marbles in his head, along with an ins. co. adjudicator who doesn't even have the marbles!
There is no point in doing a finger stick if you aren't going to use the information and it isn't only a matter of training. My wife who is boderline T2 has a great deal of practical knowledge but rarely decides that she has to give up or cut back on a certain meal because of a post meal result. It is also not very useful to simply test fasting blood sugar each morning. If you aren't managing basal, what can you really do about it on a day to day basis?
The way forward is to convince newly diagnosed T2s that they are responsible for keeping their blood sugar within defined ranges and teaching them to eat to meter. That isn't the standard medical approach with its the patient is helpless/non-compliant attitude.
I tested a lot in the beginning and now am down to about 3 times a day, mostly after meals. I already purchase my own strips because of a $11,000 deductible on my insurance. It is a cost I am willing to bear to control this disease. I don't really think it matters what some study says. My HbA1c went from almost to 11 to the low 5's. I know from daily testing that when I go over 15 carbs a meal I pay for it with higher bgs the next day. I am a well controlled diabetic because of my bg testing at the right times. I would love my insurance company to pay for my strips, but it won't affect my testing.
Brunetta, I know many similar stories. Before I retired, there were 2 new T2s at work who said their docs told them their 7.5 A1Cs indicated "prediabetes." They ate all sorts of crap because they were told to keep doing what they're doing, maybe lose a little weight. Finally one day I pulled off my shoe to show them I only have 4 2/3 toes. "My A1c has been below 5.3 for 4 years, and I've still lost toes" I said. "Good luck."
Consumene.. It is so sad and horrible that people ARE NOT adequately educated! In my African-American community where tyoe 2 is quite prevalent; Many diabetics are convinced,particularly the elderly ones, that "I have a little bit of sugar, no big deal" . Some diabetics feel that they cannot be" bothered with all that testing" since the doctor told them that 7.5 is "good enough. And many are not on any meds nor have they received any dietary directions nor consultations . This so very very common in the diabetics I talk to. ( Though they would not want to refer to themselves that way, as "diabetic". Are the doctors waiting for complications to set in before they treat or educate their patients?.. It is so frustrating to convince other newly and some not so newly diagnosed diabetics that they can self-manage the big "D": I am very nice, nonjudgmental; and I do not present too Much information at one time. They kind of listen to me, but then tell me "You wear an insulin pump and have the bad diabetes, so I do not have to do what you do!!" Sheesh!!
I still have eight toes, so I guess I have the "good" diabetes. I was on a pump for years and testing like crazy, but still lost a few toes, vision,and neuropathy. The more you know the better you go!
of course... just imagine how much they have to spend on us each year! without us, more money could go into the military where we really need it! /sarcasm
