Q:Ā Should all diabetics test their blood sugar at home?
A: More than 30 million people in the United States have diabetes. The vast majority have Type 2. Some of those are testing their blood sugar at home, but the best research is telling us they do not need to ā that in fact it is a waste of money.Ā
It is not a small problem. The waste runs into the billions of dollars and it is costing all of us money through the health care system.Ā
For people with Type 1 diabetes, blood glucose monitoring and insulin administration is the standard of care. Patients need to check their blood sugar a number of times a day, then give themselves insulin to replace what would have been made in the pancreas. Treatment for Type 2 diabetes does not involveĀ such critical calculations. It is usually maintained with pretty regular administration of the same drugs on a set schedule.Ā
Self-monitoring for blood glucose has been tested in well-designed studies.Ā
The Monitor trial, published two years ago in JAMA, was a pragmatic trial that took place in 15 primary care practices in North Carolina. Patients with Type 2 noninsulin-treated diabetes were randomly assigned to one of three groups.
People in the first group were told to check their blood glucose once a day. People in the second were told to check their blood glucose once a day and then were given tailored advice depending on the results from the meter. The third group was told not to check blood sugar at all.Ā
After one year (a pretty impressive length for a study like this), there were no differences in the hemoglobin A1C levels (the best way to monitor long-term blood glucose control) between the three groups. There were also no differences in the health-related quality of life measures for the patients. There were no differences in the number of times they experienced hypoglycemia, how much care they needed and how many progressed to the need for insulin.Ā
In other words, there were no measurable differences in how patients fared, whether they checked blood sugar or not. This evidence, the best to date, confirmed what previous work had shown.Ā Still, not everyone is on board. Critics of this most recent trial said it did not prove that blood glucose monitoring could not help, if done better.Ā
The point of pragmatic trials like this, though, is to test how practices work in the real world. In these high-quality primary care practices, even with customized help in interpreting the measurements (more than most patients get), testing blood sugar did not make a difference.Ā
Choosing Wisely, an educational campaign aiming to reduce unnecessary medical tests and procedures, advises against routine home glucose monitoring for patients with Type 2 diabetes who are not on insulin. It says that there is no benefit and that there are potential harms. This argument is supported by the American Academy of Family Physicians, the Society of General Internal Medicine and the Endocrine Society.
That message is not getting through. At the end of last year, another study in JAMA Internal Medicine quantified the prevalence of glucose testing in adults. Researchers examined a databaseĀ of more than 370,000 commercial health insurance and Medicare Advantage beneficiaries who had Type 2 diabetes.Ā
Of the more than 23 percent of patients who were using testing strips, more than half were probably doing so despite widespread recommendations that they shouldnāt. They were using a median of two testing strips a day, at a cost of more than $325 per year per patient.
ā Aaron E. Carroll, The New York Times