Too Much Type 2 Diabetes Testing?

Here at, we often stress the importance of monitoring your blood glucose levels. After all, studies have shown that blood glucose control is key to lowering your risk of developing complications of diabetes, such as eye, kidney, or nerve damage. But according to a new study, doctors often measure the blood glucose control of people with Type 2 diabetes too frequently — and, as a result, sometimes prescribe treatments that are too aggressive for their patients’ overall health and well-being.

The study, published last week in the journal BMJ, looked at over 30,000 adults with Type 2 diabetes whose blood glucose was well controlled, defined as having an HbA1c level (a measure of long-term blood glucose control) below 7%. The average age of the study group was 58. As noted in a HealthDay article on the study, guidelines from groups like the American Diabetes Association state that in people who have a recent history of good blood glucose control, the HbA1c test should only be given by doctors once or twice a year. Yet in this group of people with well-controlled diabetes, 55% had an HbA1c test three or four times a year, and another 6% had the test at least five times a year.


But the cost of all these extra tests, and the inconvenience involved, aren’t the only drawbacks to this testing. The study also showed that excessive testing was associated with doctors intensifying a patient’s diabetes treatment — that is, prescribing more drugs (including insulin), some with the potential to lower blood glucose too much and cause hypoglycemia. In fact, study members were 35% more likely to receive intensified treatment if their doctor tested their HbA1c more than the recommended amount. Despite good blood glucose control, 8.4% of study members experienced intensified treatment.

The study’s authors speculated that overtesting may be driven by both doctors and patients, who have trouble resisting the impulse to monitor their condition as closely as possible. Furthermore, they posit, doctors are conditioned to treat a patient even when refraining from treatment might be the wiser course of action. In the case of diabetes, having very low blood glucose has been associated with an increased risk of a heart attack or stroke among older people.

What’s your take on this study — do you think overtesting and overtreatment of Type 2 diabetes are major problems, or are lack of blood glucose awareness and undertreatment the bigger issues? How often do you get an HbA1c test? Do you think getting the test more often — or less often — would change how you go about managing your diabetes? Are you and your doctor striving for very tight blood glucose control (such as an HbA1c level below 6%)? If so, have you experienced an increase in hypoglycemia since you started aiming for such a low number? Leave a comment below!

  • Samwell Baggins

    I got my diagnosis in June 2014 with an A1c of 7.3 and a casual blood glucose of about 200. I lost weight, exercised and ate healthy. Within 10 weeks, the A1c was 5.5.My next A1c in December 2014 was 4.9, and my latest A1c in 2015 was 4.8.I may be one of the exceptions and not the rule, as my blood glucose is directly tied to my weight and no other known metabolic causes.Lipid and metabolic panels are stable and good as well.

    My doctor only consented recently to twice-a-year testing after I was stable for one year and showed no signs of hypoglycemia.The doctor insisted on the frequent testing due to a possible *honeymoon period* and that he had seen other patients make a quick improvement like me and a year later be in the same dire situation. We never had intensive control of my health, and we de-intensified as the numbers improved (as in no Metformin after ten weeks, as BG was going into the mid-60s with vigorous exercise).

    I liked the aggressive testing at the beginning, as my goals were being met. If my target goals were not met and maintained, I may have felt different about being tested four times a year. On a high-deductible health plan, these metabolic tests are expensive.I have to take responsibility for my health and weight without much oversight now, and so far, it is working. We’ll see how I do in March 2016.

  • maris

    when diagnosed in 2012 my A1C was 13.1 and I was tested every three months. In Feb.2013 it was 6.8 in May 2014 it was 5.9 now I get my A1C done every six months. HDL LDL triglycerides are in normal limits. My Dr. cut my meds from 4-500 mg. per day to 1-500 mg. per day my bp meds have been cut in half. Love my Dr.