Study Finds Glucose Self-Monitoring Does Not Improve Glycemic Control for Diabetics

Incorporating technology into self-management activities has been touted as potentially transformative for patients, yet one recent study found that diabetic patients who self-monitored their blood glucose levels at home did not control their conditions any better than patients who did not self-monitor.

The study, titled “Glucose Self-Monitoring in Non-Insulin-Treated Patients with Type 2 Diabetes in Primary Care Settings,” was published in JAMA Internal Medicine. For the study, physician researchers at the University of North Carolina at Chapel Hill School of Medicine, examined the value of self-monitoring of blood glucose levels in patients with non-insulin-treated type 2 diabetes and examined three approaches of self-monitoring for effects on hemoglobin A1c levels and health-related quality of life.

The study involved 450 patients at 15 primary care practices in central North Carolina with type 2 non-insulin-treated diabetes and with glycemic control (hemoglobin A1c) levels higher than 6.5 percent but lower than 9.5 percent within the six months preceding screening.

For the study, which was conducted over year, a third of patients did not self-monitor, one-third of patients conducted standard once-daily self-monitoring and one-third of patients self-monitored and received automated, tailored messaging.

After one year, the researchers found no evidence that self-monitoring led to improved glycemic control and no significant differences found in health-related quality of life between patients who performed once-daily self-monitoring with those who did not self-monitor.

“The addition of instant tailored feedback messages via a meter did not improve glycemic control. This null result occurred despite training participants and primary care clinicians on the use and interpretation of the meter results. These findings align with earlier studies and a group that reinforce the limited utility of self-monitoring of blood glucose (SMBG) in patients with non–insulin-treated T2DM,” the study authors wrote.

Further, the study authors wrote, “Surprisingly, SMBG has remained a cornerstone in the clinical management of non–insulin-treated T2DM, in part fueled by other studies and groups supporting glycemic control with SMBG. As the first large pragmatic US trial of SMBG, our findings provide evidence to guide patients and clinicians making important clinical decisions about routine blood glucose monitoring.”

Incorporating technology into self-management activities has been touted as potentially transformative for patients, and to date some smaller studies support this notion,” the study authors wrote, adding, “However, our findings do not.”

The study authors also theorize that the use the enhancement of self-monitoring with one-way messaging back to the patient does not adequately engage patients. A more interactive approach or the use of 2-way messaging between the patient and physician may improve the durability of this approach, the study authors wrote.

The study authors also concluded, “Based on these findings, patients and clinicians should engage in dialogue regarding SMBG with the current evidence suggesting that SMBG should not be routine for most patients with non–insulin-treated T2DM.”