Self-monitoring of blood glucose for people with Type 2 diabetes is often a contentious topic. There is little doubt, of course, that for people with diabetes who take insulin, self-monitoring plays a crucial role in calculating the correct dose, allowing for far better blood glucose control than would otherwise be possible without a very high risk of hypoglycemia (low blood glucose). But for people with Type 2 diabetes who don’t take insulin (or an oral diabetes drug that carries the risk of hypoglycemia), there is longstanding debate about whether self-monitoring is worthwhile, with some experts arguing that it is a waste of time, money, and effort for most people.
Two major medical organizations have just taken a side in this argument. In their contribution to the American Board of Internal Medicine’s “Choosing Wisely” campaign — an initiative in which medical organizations submit a list of “Five Things Physicians and Patients Should Question” in their field — The Endocrine Society and the American Association of Clinical Endocrinologists put self-monitoring first on their list: “Avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia.” They go on to note exceptions when monitoring is a good idea for everyone, including during illness, when new medications are added, or if HbA1c begins to rise. But the groups note that self-monitoring appears to have little benefit unless it is used to learn how foods or activities affect blood glucose, or to adjust diabetes treatment in some way.
David Spero addressed the topic of “Mindful Glucose Monitoring” in a blog post here at DiabetesSelfManagement.com last year. In the dozens of comments left in response to his post, readers took both sides in the self-monitoring debate. While some noted that self-monitoring allowed them to learn how foods affected them following their diabetes diagnosis, others questioned whether their current self-monitoring routine was doing them any good. Some wrote that they kept a log of their numbers for their doctor but did nothing else with their results, and that their doctor only quickly skimmed the numbers. Yet those who used self-monitoring to learn about their response to foods tended to view it as indispensable, even if they stopped monitoring frequently once all of their favorite foods and meals had been covered.
People with diabetes aren’t the only ones arguing about self-monitoring — doctors are, too. In back-and-forth commentary and letters published in the journal Diabetes Care several years ago, a self-monitoring skeptic noted that in most randomized controlled trials of self-monitoring for people with Type 2 diabetes who don’t take insulin, no significant difference in HbA1c level has been seen as a result of monitoring. Proponents of self-monitoring noted that in a meta-analysis (combined analysis of several studies), they found that people not on insulin who self-monitored had an HbA1c level 0.39% lower, on average, than those who didn’t monitor, with the resulting lower rate of diabetes complications offsetting some of the costs of monitoring. The self-monitoring skeptic countered that the enormous sum of money spent on self-monitoring — estimated at nearly $1.5 billion each year in the United States — could probably do a better job at lowering diabetes complications if some of it were put to a different use (for example, paying for diabetes education). He notes that if self-monitoring were a drug, the US Food and Drug Administration (FDA) most certainly wouldn’t approve it for people who don’t take insulin, based on its rate of effectiveness at lowering HbA1c.
What do you think — if self-monitoring necessary or helpful for people with Type 2 diabetes who don’t take insulin? If so, is routine monitoring helpful, or is it only useful at certain times, such as when trying new foods or during illness? Should doctors and patients take cost — direct or indirect — into account when deciding how often to self-monitor? Would you self-monitor as much as you do if you had to pay the full cost of your test strips? Leave a comment below!