Diabetes Self-Management Blog

Two just-published studies in BMJ, the British Medical Journal, suggest that people with Type 2 diabetes don’t need to monitor their blood glucose much, unless they’re on insulin. You heard it here first.

This is an old debate. I’m going to tell you what I think, but I’d really like to hear your experiences and opinions.

One article is called “Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes.”

This study followed three groups of people (a total of 453 participants) who had had diabetes for at least 12 months. All groups got standard care. One group did no blood glucose monitoring. Another was taught to check blood glucose levels, but not what to do about them. The third group learned self-monitoring and also received “additional training in incorporating the results into self-care.”

The study lasted one year and looked at two outcomes: expense and quality of life (called “Quality adjusted life years.”)

The results showed that self-monitoring cost approximately an extra 84 pounds ($164) a year. Interestingly, the group that had been taught what to do about their blood glucose results spent a bit less than the group that was just monitoring and writing the numbers down.

When it came to quality of life, “an initial negative impact of self monitoring on quality of life occurred,” moreso in the group that received the advanced training. This was not a huge effect (about 3% in one group and about 7% in the other), but it was a significant negative.

The researchers concluded that “self-monitoring of blood glucose with or without additional training in incorporating the results into self care was associated with higher costs and lower quality of life in patients with non-insulin treated type 2 diabetes. In light of this, and no clinically significant differences in other outcomes, self monitoring of blood glucose is unlikely to be cost effective in addition to standardised usual care.”

What about health outcomes?

The other study is called “Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes.”

In this trial, 184 non-insulin-using patients at hospital diabetes clinics, who had no experience in self-monitoring, were split into a blood-glucose-monitoring group and a no-monitoring group and followed for one year. Both groups received identical education programs. The self-monitoring group received additional education on how and when to check their blood glucose.

The participants were followed every three months for one year. Their HbA1c levels, use of oral diabetes drugs, body mass index (BMI), and psychological well-being were measured.

No Differences Found
There were no significant differences between groups at any time point in the study. HbA1c levels, BMIs, and oral medicine use were all about the same. Monitoring was associated with a 6% higher score on the depression subscale of the well-being questionnaire, a very significant result. The experimenters conclude that, “In patients with newly diagnosed type 2 diabetes, self monitoring of blood glucose concentration has no effect on glycemic control but is associated with higher scores on a depression subscale.”

My Take
In my practice and in my book Diabetes: Sugar-coated Crisis, I caution people against monitoring without a plan. Sticking yourself, obtaining numbers, writing them down, and showing them to the doctor twice a year will not do you much good.

Monitoring with a purpose can be valuable. You can learn how much different foods raise your blood sugar, or how much a certain amount of exercise lowers it. You might find out how certain stressful events or certain medications affect you.

But you don’t have to do those kind of tests every day. Just check when you’re trying to find specific information.

It’s different if you’re on insulin, of course. There, monitoring is a question of safety. Sick days might also call for monitoring, as blood sugar levels can go high very rapidly when you’re sick.

So I believe everyone with Type 2 diabetes should know how to check their blood glucose. But for most people, I don’t think you need to do it very often, if you’re feeling good. When you’re feeling poorly physically or emotionally, it’s probably a good idea to check.

For overall self-monitoring, knowing your HbA1c will give you a better idea. A random blood glucose check only gives you a snapshot of one moment in time. An HbA1c result gives you a picture of where you’ve been for the last four to eight weeks.

What Do You Think?
Well, that’s my view, supported by the BMJ studies. What do you think, people with Type 2 diabetes? Has self-monitoring your blood glucose helped you? How much of it do you do? Do you think you could cut back or stop? Or are these studies wrong in some way? Please comment here.

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