SMBG fails to improve glycemic control in adults with type 2 diabetes

SAN DIEGO — Self-monitoring of blood glucose with or without tailored messages did not significantly improve glycemic control compared with no self-monitoring of blood glucose in adults with type 2 diabetes.

“Some patients may feel that home monitoring helps them to feel in better control of their health — for them, the data may be useful,” Katrina Donahue, MD, MPH, professor and research director of the department of family medicine at the University of North Carolina at Chapel Hill, told Endocrine Today. “Some patients may question the process of home monitoring and instead favor different approaches to managing their health.”

Katrina Donahue

Donahue and colleagues evaluated 450 adults (mean age, 61 years) with type 2 diabetes (mean duration, 8 years) who were not treated with insulin randomly assigned to once-daily SMBG, once-daily SMBG with enhanced patient feedback including automatic tailored messages delivered by the meter or no SMBG to compare the three approaches for effects on HbA1c and health-related quality of life. Participants were randomly assigned between January 2014 and July 2015, and follow-up was conducted for 1 year.

At baseline, 75% of participants were performing SMBG, and testing preference at baseline was 22% preferring no SMBG and 40% preferred SMBG; 80% of participants were assigned metformin and 35% were assigned sulphonylureas.

At 1 year, there were no differences between the groups for glycemic control, health-related quality of life or insulin initiation. Further, no differences were found between the groups for patient-reported outcomes by the Problem Areas in Diabetes, Diabetes Symptom Checklist, Diabetes Empowerment Scale, Diabetes Treatment Satisfaction or the Communication Assessment Tool.

Compared with the no SMBG group, participants in both SMBG groups taking a GLP-1 agonist at baseline were more likely to increase their dose (P = .02). Thiazolidinedione initiation was more likely in participants in the SMBG plus messaging group compared with the other two groups (P = .01).

“Patients and providers have to consider each unique situation as they determine whether home blood glucose monitoring is appropriate,” Donahue said. “However, the study’s results suggest that [SMBG] in non-insulin-treated type 2 diabetes has limited utility. For the majority, 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, at least until insulin treatment is required.” – by Amber Cox

Reference s :

Young LA, et al. JAMA Intern Med. 2017;doi:10.1001/jamainternmed.2017.1233.

Young LA, et al. 891-P. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.

Disclosure: Donahue reports the University of North Carolina has licensed its interest in copyright works to Telcare of a glucose messaging and treatment algorithm for the purposes of commercialization.