Put away those costly test strips – self-testing useless for most diabetes patients

A recent study has revealed that self-monitoring of blood glucose levels by type-2 diabetes patients does not do anything to improve their health-related quality of life.

The results of a randomised trial indicated that self-monitoring should not be a routine in case of Type-2 diabetes patients. Many Type-2 diabetes patients who are not treated with insulin undergo self-monitoring of blood glucose levels, although the accuracy of value has been debated for long.

For those treated with insulin, checking blood sugar with a finger stick at home is an accepted practice for monitoring the effects of insulin therapy. However, the majority of type-2 diabetes patients are not treated with insulin. These patients, too, are often recommended glucose monitoring, despite an ongoing debate about its effectiveness in controlling diabetes or improving how patients feel.

Treatment plans don't change based on blood sugar test results. Patients don't change the dosage of their oral diabetes drugs and they don't alter their insulin use (which one-quarter of people with type-2 diabetes are on) because of this.

Self-testing also drives up the cost of having diabetes. Although glucose meters are often heavily discounted and, in some cases, provided for free, test strips costs are high, despite costing just pennies to make. Many patients perform the finger-stick blood sugar test several times a day.

Even doctors don't pay attention to the finger-stick blood sugar test. Instead, they base treatment decisions on hemoglobin A1C, a test that measures your average blood sugar levels during a six- to eight-week period. If the A1C is going up, therapy is intensified. Conversely, if A1C is falling, medication dosages may be revised downward.

Katrina E Donahue and Laura A Young of the University of North Carolina conducted a study with 450 patients with non-insulin-treated Type-2 diabetes. The patients analysed were an average of 61 years old and had diabetes for an average of eight years. Of these, 75 per cent were regularly performing SMBG, or self-testing.

The patients were given to one of three groups, that is, those who performed no SMBG, those who performed SMBG once every day and those who performed SMBG daily and also received enhanced feedback messages through their blood glucose meters. The study analysed haemoglobin A1c levels in all the three groups and health-related quality of life after one year. The results signified that there was no significant difference in glycemic control or health-related quality of life after a year between patients who did SMBG compared with those who didn't.

Attrition in the SMBG monitoring groups could explain why some improvements were initially seen in hemoglobin A1c levels in the early months that weren't significant at 12 months, according to the study. The study also did not determine the effectiveness of SMBG in certain clinical situations, such as when a new medication is started or when a dose is changed.

The authors warn the results do not apply to patients with diabetes treated with insulin. 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 [type 2 diabetes mellitus].

The study is published by JAMA Internal Medicine