Chapel Hill, NC—When type 2 diabetes patients not on insulin come into pharmacies to purchase finger-stick testing supplies, are they just wasting money?
A new study in JAMA Internal Medicine questions whether that might be case, pointing out that home blood sugar testing doesn’t show much benefit for those patients.
In “The MONITOR Trial,” University of North Carolina School of Medicine–led researchers suggest that neither glucose control nor quality of life is improved by frequent home finger-stick testing.
“Our study results have the potential to transform current clinical practice for patients and their providers by placing a spotlight on the perennial question, ‘to test or not to test?’” explained Katrina Donahue, MD, MPH, senior author of the study and professor and director of research at UNC Family Medicine.
For the randomized trial, 450 patients were assigned to one of three groups:
• No blood glucose monitoring at all
• Once daily glucose monitoring, or
• Enhanced once-daily glucose monitoring with encouragement and/or instruction via the Internet.
After a year, results indicate no significant differences in blood glucose control, hypoglycemia, hospitalizations, emergency department visits, or health-related quality of life when the three groups were compared.
The study also found that diabetes patients who didn’t test their blood sugar were no more likely to need to initiate insulin treatment than those who did.
“Of course, patients and providers have to consider each unique situation as they determine whether home blood glucose monitoring is appropriate,” Donahue said. “But the study’s null results suggest 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.”
Yet 75% of type 2 diabetes patients are advised to regularly check their blood glucose at home, even though the overwhelming majority don’t use insulin, according to background information in the article.
While proponents of blood-glucose testing tout the influence of glucose-level awareness on improving diet and awareness, study authors suggest that small clinical trials testing that hypothesis have shown mixed results. They also point to the financial cost of daily testing, as well as the inconvenience and discomfort.
“There has been a lack of consensus, not just in the United States, but worldwide,” explained first author Laura Young, MD, PhD. “The lack of standard guidelines makes it all the more difficult for patients, who are already struggling to manage a chronic condition. And at the end of the day, patients have to make a choice.”
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