Glucose Self-Monitoring May Not Be Beneficial in T2DM, Says Landmark Study
This article is part of MPR's coverage of the American Diabetes Association's 77th Scientific Sessions (ADA 2017), taking place in San Diego, CA. Our staff will report on medical research and technological advances in diabetes and diabetes education, conducted by experts in the field. Check back regularly for more news from ADA 2017.
Patients with non-insulin-treated type 2 diabetes mellitus (T2DM) who self-monitor blood glucose do not appear to have significantly better outcomes with regards to glycemic control or health-related quality of life (HRQOL) compared to those who do not self-monitor. Findings from this study were presented by researchers from the University of North Carolina School of Medicine at the American Diabetes Association 77th Scientific Sessions, held June 9–13 in San Diego, California and were also published online in JAMA Internal Medicine.
"The value of self-monitoring of blood glucose (SMBG) for patients with non–insulin-treated type 2 diabetes mellitus (T2DM) has been debated, yet over 75% perform regular SMBG," the authors noted. Those for testing say it encourages better disease awareness and may help patients improve their diets and lifestyle, however other studies have shown no benefit with daily testing and even potential harms (ie, stress, financial costs). In order to get a better understanding of the benefits and harms associated with routine SMGB in these patients, researchers conducted a pragmatic, open-label randomized trial involving 15 primary care practices (MONITOR trial).
Study patients (n=450) were divided to one of three groups: no blood glucose monitoring, once-daily blood glucose monitoring, or enhanced once-daily blood glucose monitoring with an internet-delivered custom message of encouragement or instruction.
Results showed that by the end of the 1-year study, there were no significant differences in hemoglobin A1C levels or HRQOL across the three arms. In addition, there were no observable differences in adverse events such as hypoglycemia, hospitalization/emergency room visits, or insulin initiation.
Senior author Katrina Donahue, MD, MPH, stated that although each patient-provider situation is unique to determine whether home blood glucose monitoring is appropriate...the study's null results suggests that self-monitoring of blood glucose in non-insulin treated type 2 diabetes has limited utility. For the majority, the costs may outweigh the benefits."
Overall, patients with diabetes should discuss the need for blood glucose monitoring with their healthcare providers, the authors concluded.
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