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Glucose Self-Monitoring in Non-Insulin Treated Patients with T2D

JAMA Intern Med; ePub 2017 Jun 10; Young, et al

Publish date:

For most patients with non-insulin-treated type 2 diabetes, routine self-monitoring of blood glucose levels does not significantly improve hemoglobin A1c levels or health-related quality of life (HRQOL), a recent study found. The Monitor Trial study was conducted in 15 primary care practices in North Carolina between January 2014 and July 2015. Eligible patients (aged <30 years) with type 2 non-insulin-treated diabetes were established with a PCP at a participating practice and had glycemic control levels >6.5% but lower than 9.5% within the 6 months preceding screening. Patients were randomized to 1 of 3 groups: no self-monitoring of blood glucose (SMBG), once-daily SMBG, and once-daily SMBG with enhanced patient feedback. Researchers found:

  • 450 patients were randomized; 418 (93%) completed the final visit.
  • There were no clinically or statistically significant differences at 1 year in glycemic control or HRQOL between patients who performed SMBG vs those who did not.
  • The addition of tailored feedback through messaging via a meter did not provide any advantage in glycemic control.

Citation:

Young LA, Buse JB, Weaver MA, et al. Glucose self-monitoring in non–insulin-treated patients with type 2 diabetes in primary care settings. A randomized trial. [Published online ahead of print June 10, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.1233.

Commentary:

It seems intuitively obvious that self-monitoring of blood glucose in patients on oral agents for type 2 diabetes would improve their glucose control. Unfortunately, that which is obvious is not always correct, and this study, along with a number of previous studies, does not support the contention that self-monitoring for patients on oral agents with type 2 diabetes improved diabetes control.1,2 What clinical practice conclusions should we draw from this study? First, the evidence suggests that self-monitoring of blood glucose is not a necessary part of care for all patients with type 2 diabetes. Second, self-monitoring of blood glucose may still have efficacy for select patients who are highly motivated and would find feedback of self-monitoring useful, as well as for patients who are at elevated risk for hypoglycemia. —Neil Skolnik, MD

  1. Davidson MB, Castellanos M, Kain D, Duran P. The effect of self monitoring of blood glucose concentrations on glycated hemoglobin levels in diabetic patients not taking insulin: a blinded, randomized trial. Am J Med. 2005;118(4):422-425.
  2. O’Kane MJ, Bunting B, Copeland M, Coates VE; ESMON study group. Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial. BMJ. 2008;336(7654):1174-1177. doi:10.1136/bmj.39534.571644.BE.

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