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Self-monitoring of blood glucose reduces health care costs, has little impact on patients

Self-monitoring of blood glucose in patients with noninsulin-treated type 2 diabetes may lower health care spending with little to no harm to these patients, according to findings recently published in Annals of Family Medicine.

“Self-monitoring of blood glucose can be painful, inconvenient and depressing. The Society of General Internal Medicine advises against daily glucose testing, yet the American Diabetes Association recommends it. Proponents of daily glucose monitoring argue that it improves glycemic control, distress and self-efficacy when used in a targeted manner,” Sonia A. Havele, MD candidate at Case Western Reserve University School of Medicine, and colleagues wrote. “Examining to what extent and why physicians continue to recommend [self-monitoring of blood glucose] is essential for understanding how this debate permeates care.”

Researchers interviewed 10 family medicine doctors and seven internists regarding their beliefs about self-monitoring of blood glucose in patients with noninsulin-treated type 2 diabetes, whether they recommend it, and its utilization in the course of clinical encounters. These clinicians were all from one medical facility and provided limited demographic information.

Four main themes emerged from the interviews, according to researchers:

Education for lifestyle change: proponents of self-monitoring of blood glucose to most patients with noninsulin-treated type 2 diabetes revealed self-monitoring is most effective at initial diagnosis as well as facilitating self-management and education.

Value-based care: all physicians, regardless of their opinions about self-monitoring of blood glucose, agreed that HbA1c levels exceed self-monitoring of blood glucose when making medication choices.

Patient safety: physicians on both sides of the self-monitoring of blood glucose debate said hypoglycemia concerns justified prescribing self-monitoring of blood glucose.

Considerations for specific patient populations: physicians on both sides of the self-monitoring of blood glucose debate ascertained certain patients, such as those with cognitive or physical disability, were not ideally suited for self-monitoring of blood glucose.

“Semistructured phone interviews with 17 primary care physicians indicated that the majority continue to recommend routine self-monitoring of blood glucose due to a compelling belief in its ability to promote the lifestyle changes needed for glycemic control,” Havele and colleagues wrote.

“Health care systems can look to [self-monitoring of blood glucose] as an opportunity to reduce spending with little to no harm to patients,” they added. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.