New study finds no reason for glucose monitoring in many Type 2 diabetics

Diabetics who are treated with insulin are instructed to check their glucose levels routinely so that they can adjust their insulin doses if levels are too high or too low. 

Many type 2 diabetics who are not treated with insulin use self-monitoring to help check whether their glucose levels are under control. Now a new study on regular glucose monitoring for people with non-insulin-dependent type 2 diabetes has found that for these patients, daily monitoring of glucose levels did not improve either the patients' glucose control or their quality of life. As a result of the study, the authors suggest these patients should not routinely monitor their glucose levels. The study was published in the Journal of the American Medical Association Internal Medicine and presented at the recent Scientific Sessions of the American Diabetes Association. 

People with type 2 diabetes, the most common form in Australia, may produce insulin, but they either do not produce enough or their body has become resistant to its effects. Treatment depends on the severity of the condition. Type 2 diabetics range from those who can control their glucose levels with diet and exercise, to those who take oral medications, to those who need to take daily insulin injections. Though many type 2 diabetics who do not need insulin routinely self-check their glucose one or more times a day, the practice has been questioned.

The recent one-year JAMA study was conducted at more than a dozen primary care medical practices in North Carolina in the USA and included 450 patients with type 2 diabetes, with an average age of 61. Patients were included in one of three groups: no glucose monitoring, once-daily glucose monitoring, and monitoring that included regular supportive messages about controlling type 2 diabetes. For all three groups, the researchers measured the patients' quality of life and levels of haemoglobin A1c, which evaluates the average amount of glucose in the blood over the last 2 to 3 months. At the end of the study, the researchers found no differences in quality of life or glucose control between patients who checked their glucose levels and those who didn't.

Katrina Donahue, MD, PhD, the senior author of the paper and the director of research at the University of North Carolina Division of Family Medicine, says the decision to test or not for people with type 2 diabetes has been left up to providers and patients. However, she has found in her own work that "daily testing imposes not only a financial cost, but can also take a mental toll, increasing the rate of depression or anxiety in some patients." Adds Dr. Donahue, "patients and providers should consider each unique situation as they determine whether home blood glucose monitoring is appropriate…” "For the majority," says Dr. Donahue, "the costs may outweigh the benefits. If patient and provider determine that home monitoring is not necessary, it could save the patient hundreds of finger sticks and hundreds of dollars every year."

Further reading
EurekAlert! summary
JAMA Internal Medicine abstract

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