Stop Monitoring for Type 2 Diabetes?
A team of researchers from Queen Mary University of London suggest that it’s possible for many people who have type 2 diabetes to stop self monitoring their blood glucose. If this approach is implemented, it could mean a significant cost savings and the elimination of discomfort and stress for millions of people.
Self monitoring for type 2 diabetes, as it does for type 1 diabetes, typically involves performing a finger prick several times a day to identify blood sugar levels. For individuals with type 1 diabetes, who take insulin, this self monitoring is absolutely necessary.
However, among people with type 2 diabetes, those who do not use insulin may be wasting their time and money. That conclusion was reached based on the results of a newly published study.
Stop self monitoring?
Previous research has provided evidence that routine self monitoring of blood glucose is not necessary, including trials showing no “clinically meaningful improvement in either glycaemic control or hypoglycaemia.” At the same time, such monitoring is associated with anxiety, depression, and poorer quality of life.
In the new study, data from about 35,000 individuals were evaluated. The investigators followed 19,602 patients recruited from two intervention clinical commissioning groups in London. All had type 2 diabetes and were not being treated with insulin. A control group of 16,033 patients also was analyzed.
The approach used by the doctors in the intervention clinical groups is known as COM-B, a behavior system that involves three conditions: capability, opportunity, and motivation. Basically, the doctors were provided with guidelines to assist them in helping their patients make the change, including educational meetings to explain the guidelines and improve knowledge and capability, pamphlets for patients, patient reviews, and electronic reminders to enhance motivation and improve opportunities for change via comparative performance feedback.
Results of the study
At the end of a four-year evaluation period, here were the results:
- Use of self monitoring of blood glucose declined in the two intervention groups from 42.8 percent to 16.5 percent compared with a decline from 56.4 percent to 47.2 percent in the control group
- Among those in the intervention groups who were using metformin alone or no treatment, self monitoring declined from 29.6 percent to 6 percent, compared with a drop from 47.1 percent to 38.7 percent in the control group
- The total cost for all self monitoring blood glucose prescribing over the four years (which included both type 1 and type 2 diabetes and insulin users) declined by 4.9 percent in the two intervention groups and increased by 5 percent in the control group
- Overall, 20 percent fewer patients used self monitoring of blood glucose in the two intervention groups
- The authors projected that if this program were instituted nationally, it would result in the elimination of unnecessary glucose testing in 340,000 individuals and save a total of 21.8 million pounds (1 English pound is approximately $1.50 US)
In conclusion, the results of this study suggest that unnecessary use of self monitoring of blood glucose can be significantly reduced once doctors and their patients utilize a simple program that combines education, reviews, and motivation. The benefits of such an approach include less financial burden on the healthcare system and patients and a better quality of life for those with type 2 diabetes. Anyone with type 2 diabetes who is not taking insulin and is interested in stopping self monitoring should talk to their doctor before taking that step.
Farmer AJ et al. Meta-analysis of individual patient data in randomized trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. BMJ 2012 Feb 27; 344:3486
Michie S et al. The behavior change wheel: a new method for characterizing and designing behavior change interventions. Implementation Science 2011; 6:42
O’Kane MJ et al. Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study). Randomized controlled trial. BMJ 2008; 336(7654): 1174-77
Robson J et al. Reduction in self-monitoring of blood glucose in type 2 diabetes: an observational controlled study in east London. British Journal of General Practice 2015 Apr. 1