With lack of data, meaningful monitoring should be employed

WASHINGTON, D.C. — Experts here lamented the lack of high-quality data measuring success or inefficacy of glucose monitoring, but they turned to the idea of meaningful monitoring at a time when data have been outrun by technology.

“Meaningful monitoring is something that should be unimpeachable,” Daniel Einhorn, MD, MD, FACP, FACE, said during the Glucose Monitoring Consensus Conference convened by the American Association of Clinical Endocrinologists. “The person is acting on the information; sometimes you need a lot more and sometimes you need a lot less. … When you begin your journey in diabetes, you don’t know your pattern.”

Daniel Einhorn

Physician–patient relationship

This idea of meaningful monitoring begins with an improvement in the physician–patient relationship, according to the experts.

“Clinicians often aren’t brought into the conversation with patients as far as the data that patients require with monitoring,” Eric A. Orzeck, MD, FACP, FACE, said when offering insight to the question of glycemic control benefits. “The patients don’t feel empowered to use the data or even obtain it appropriately. … There must be an issue as far as the clinician involvement.”

He added that this relates to setting individual standards for patients.

“What nobody could agree upon was what frequency [of testing] was needed to acquire the expected [HbA1c] outcome,” Orzeck said. “Any one test a day could potentially lower the HbA1c by 0.3%. … You couldn’t put a number on one test. It has to be a series of tests and this had to be clinician-controlled with the patient as to what the number of tests would be and the outcome and use of the data from those tests.”

Bill Law Jr., MD, FACP, FACE, said the ability for a patient or physician to take action based upon glucose monitoring is what will make it effective in practice and in cost.

“If action is not taken on that information, there is no value,” he said.

Lack of data

Yet, experts stood firm on their instincts that glucose monitoring improves patient outcomes, but they could not point to extensive data on its efficacy or its cost benefit.

“The big issue here hovering above all of this series of deliberations is cost. Is it worth it? Do we get value from the cost?” Law asked. “The problem is that we don’t have good data showing the cost-effectiveness in glucose monitoring.”

Unfortunately, Timothy S. Bailey, MD, FACE, said a true randomized controlled trial is not feasible, nor is it ethical.

“Because we have no data, our conclusion was that there was no evidence to support the current Medicare policies on coverage, or lack thereof,” Law said. “If you’re talking about technology — for instance, meters or [continuous glucose monitoring] — the published studies addressing outcomes … lag far behind the technological advances. The technology has improved so much so rapidly and is being used clinically well beyond the published data and literature to substantiate.”

For more information: See the Endocrine Today Twitter feed for live updates of the consensus meeting: www.Twitter.com/EndocrineToday.