Type 2 Diabetes and Blood Glucose: Is There a Benefit to Testing?

Kyle Savio, Mercer University College of Pharmacy

Self-monitoring of blood glucose (SMBG) has been considered a key component of managing diabetes, allowing patients a level of autonomy and safety through detection of inappropriate blood glucose trends that may spur insulin or diet adjustments. In insulin-dependent patients, SMBG has been associated with preventing hypoglycemia. [1] Type 2 diabetes is believed to account for 90–95% of all diabetes and its treatment may not typically utilize insulin until disease progression. Diabetes guidelines have not required the use of SMBG in type 2 diabetes patients unless they are insulin-dependent. [2]

Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings [3]
Design Pragmatic, randomized; N= 450
Objective To compare effects of self-monitoring of blood glucose (SMBG) on glycosylated hemoglobin (A1c) levels and health-related quality of life (HRQOL)
Study Groups No SMBG (n= 152); SMBG (n= 150); SMBG+ (n= 148)
Methods Included patients were 30 years or older, type 2 diabetics with A1c levels between 6.5% and 9.5%, and established at a participating primary care location. Patients were excluded if they used insulin, planned to become pregnant or relocate, or had ever required diabetic assessment by an endocrinologist. Patients in the SMBG and SMBG+ groups tested blood glucose levels once daily. The SMBG+ group also received programmed responses intended to educate, motivate, or caution patients based off of blood glucose value relationship to food intake.

Values for A1c and HRQOL were assessed at baseline and 52 weeks. HRQOL was graded using the physical and mental health components from the Short Form-36 Health Survey. Point values (0-100) correlated to quality of life associated with their overall health. Higher point values were associated with an increased quality of life.

Duration 52 weeks
Primary Outcome Measure Change in A1c levels and HRQOL
Baseline Characteristics
  No SMBG SMBG SMBG+
Median age, years 61 63 61
Male, n (%) 74 (48.7) 67 (44.7) 66 (44.6)
White, n (%) 104 (68.4) 89 (59.3) 86 (58.1)
Prior use of SMBG, n (%) 138 (90.8) 135 (90.0) 143 (96.6)
Diabetes medications, n (%)
Metformin 123 (80.9) 115 (76.7) 120 (81.1)
Sulfonylurea or glinide 51 (33.6) 50 (33.3) 60 (40.5)
Thiazolidinedione 8 (5.3) 3 (2.0) 10 (6.8)
Glucagon-like-peptide 1 (GLP-1) agonist 5 (3.3) 2 (1.3) 10 (6.8)
Dipeptidyl peptidase 4 (DPP-4) inhibitor 12 (7.9) 11 (7.3) 17 (11.5)

 

Results
  No SMBG SMBG SMBG+
A1c, mean % (SD)
  Baseline 7.52 (1.12) 7.55 (1.10) 7.61 (0.97)
  Follow-up 7.55 (1.24) 7.49 (1.12) 7.51 (1.13)
  Change +0.04 (1.12) -0.05 (1.00) -0.10 (1.14)
Average of SMBG/SMBG+ vs No SMBG: p= 0.48
Physical HRQOL score, mean (SD)
  Baseline 48.72 (8.00) 47.27 (8.40) 46.22 (10.13)
  Follow-up 48.47 (7.21) 47.42 (9.03) 46.44 (9.68)
  Change -0.43 (6.86) +0.07 (6.77) -0.35 (6.95)
Average of SMBG/SMBG+ vs No SMBG: p= 0.50
Mental HRQOL score, mean (SD)
  Baseline 53.52 (9.29) 52.94 (8.77) 53.43 (9.58)
  Follow-up 53.39 (10.55) 52.04 (9.57) 52.57 (10.39)
  Change -0.94 (7.46) -0.71 (7.72) -1.39 (6.85)
Average of SMBG/SMBG+ vs No SMBG: p> 0.99

 

Adverse Events Common Adverse Events: N/A
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: N/A
Study Author Conclusions No benefit was found with once daily blood glucose monitoring for non-insulin type 2 diabetes patients.

A majority of patients were continuing their use of SMBG, and can not be used to answer if this shows benefit in newly diagnosed type 2 diabetes patients. The pragmatic, intent to treat approach was appropriate because it allowed for observation of patients in a real-time, primary care setting without excluding any variables. Although the mental HRQOL between-group difference was not statistically significant, there are negative implications for the SMBG+ group having the largest decrease. Without any clinical determinations observed, this study can only assist patient-provider conversations as to the best options for managing diabetes and potentially reducing healthcare associated costs.

 

References

[1] Malanda UL, Bot SD, Nijpels G. Self-monitoring of blood glucose in noninsulin-using type 2 diabetic patients: it is time to face the evidence. Diabetes Care. 2013;36(1):176-8.

[2] Marathe PH, Gao HX, Close KL. American Diabetes Association Standards of Medical Care in Diabetes 2017. J Diabetes. 2017.

[3] Young LA, Buse JB, Weaver MA, et al. Glucose Self-monitoring in Non-Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings: A Randomized Trial. JAMA Intern Med. 2017.

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