Friday, April 18, 2008

Glucose monitors of limited value in Type 2 Diabetes

Don't you just love Wilford Brimley. He seems so honest and trustworthy. When he tells you about ordering your diabetes supplies from Liberty, you just want to go out and get them, even if you don't have diabetes. Turns out, many diabetics probably don't need or even shouldn't test the blood sugars, as two recent studies indicate.
This shouldn't surprise us. Even in the latest diabetes guidelines on self monitored blood glucose (SMBG) from the the American Diabetes Association states:

"SMBG should be carried out three or more times daily for patients using multiple insulin injections or insulin pump therapy. (Stong Evidence)
For patients using less frequent insulin injections, noninsulin therapies, or medical nutrition therapy (MNT) alone, SMBG may be useful in achieving glycemic goals. (Weak Evidence)"

Fortunately, the majority of diabetics in this country (including the elderly) have type 2 diabetes, which often does not require insulin.

There were two studies published in BMJ today. The first looked at
184 patients less than 70 with newly diagnosed type 2 diabetes who were not on insulin and randomised them to self monitoring or no monitoring (control) groups for one year with follow-up visits every 3 months. At the end of the year, diabetes (as measured by the HbA1c) was no better in the self monitoring group. The second study looked 453 patients with type 2 diabetes who were also not on insulin, and split them up into no monitoring, less intense monitoring, and more intense monitoring. Not only did SMBG not improve diabetes control, but it also cost more and more importantly, decreased quality of life.

Glucose monitors are very useful in patient who do take insulin. I would also add that they can be useful for some patients who are not on insulin but are prone to low blood sugar (hypoglycemia), specifically patients taking sulfonylurea medications. However, many of the type 2 diabetics we see can be managed effectively with diet, exercise and one or several oral medications without the need for pricking their finger and testing their sugars all the time. In addition to Wilford, there are other commercials (Bayer) that promote glucose monitors as if they were both easy and essential. Whether it is a pill, device or even blood sugar monitor that someone is trying to sell you; make sure there is evidence to back it up.

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