SMBG for T2: A help or a hindrance?

The real issue here is exactly how the patients on monitoring and changing treatment were told to make changes, and how well the complied with the instructions.

 

If they found they had high BG readings and so decided to eat less fat, that would have meant eating more carbs, and it wouldn't have helped their BG levels. If they were told to eat less sugar and more starch if the BG readings were high, that wouldn't have helped either.

 

If they were told to "watch your diet" if the readings were too high, so they ate only a half a doughnut for a couple of days instead of their usual doughnut, that wouldn't have made much of a difference either.

 

Obviously, the National Health Service in England would like to cut costs, as would the insurance companies here, so they're not going to emphasize what really occurred.

 

There are studies showing that using continuous glucose monitors don't help A1c, but when I had a chance to use one for several months, my A1c went down a full point.

These studies (which I believe used small groups of similar people) surely shouldn't be used as an example across the world! I think instead of looking for reasons to cut testing, they should be looking at ways to improve education. It worries me that more T2s will lose some test strips out of this.

I think the important thing is to ask, as Gretchen said, what are they doing when they test? If they don't know what to do with the results then of course nothing will improve. If the education isn't there about avoiding carbs when high, which kinds of exercise work best, etc... then how CAN they improve?

Who is behind these studies? Someone who wants to save money on test strips?

I'd like to see someone else do a similar study with the right information over a good cut of the population. This time I'd like to see the T2s shown blogs and forums so they can learn from the people who have been there & done that. I bet that would show different results!

I am a Type II diabetic not on insulin. I fit the definition of the group that was evaluated. I do engage in self monitoring of blood sugar. However, I have a different approach to the evaluation of blood sugar data that is generated from the self monitoring of blood glucose (SMBG). Actually, I have written specialized software to evaluate my blood sugars. Here is what my software performs: 1. I take blood sugar readings from 60 to 90 days, and then I sort these readings according to time of day. I then use a weighted average based upon frequency of measurement to calculate a blood sugar reading which is converted by a correlation relationship of A1C to glucose concentration. I then look for trends in the data in the calculated A1C reading. Note that a trend that is established for an average is a much stronger indicator of changes in diabetic control. I have observed several changes such as these. 2. I use six sigma statistics to construct quality control charts and statistics for the evaluation of any trends in blood sugar data. If I observe the mean or standard deviation to be outside the quality control range, I investigate to see if there are circumstances that would explain why the mean or standard deviation falls outside the quality control range. 3. I perform mini glucose response tests. I will take a series of test strips, and test for blood sugar at thirty minute intervals after a meal. I evaluate the blood sugar response to a meal. For example, I was interested in the blood sugar response after eating a healthy choice salisbury steak with apple crisp. Note that I only consumed two spoons of the apple crisp. The glucose response was excellent peaking at about 165 mg/dL after about an hour. I consider this an excellent response and shows the importance of controlling portion size. In addition, I have done studies on the relationship of the weekly average in blood sugar measurement versus frequency of measurement. If more frequent measurements (say four measurements per day) was important in controlling blood sugar, then we would expect better blood sugar control with increased measurement frequency. However, I do not observe this in the data. What this strongly suggests to me is that if I take a blood sugar reading, and then take an action(avoiding certain foods, increasing exercise etc.)that this strategy is not effective in controlling blood sugars. This is because I am already in control! What all of this suggests to me is that the statistical evaluation of blood sugars that change rapidly during the course of a day is a difficult problem to evaluate. I wrote my software because I wanted to use a different approach to the analyses of my blood sugar readings.

The stated results of this study scare me because the insurance companies will jump on it as a reason to cover fewer strips, etc.  I wouldn't be at all surprised if they were behind the study in the first place and steered the way it was handled to produce the results they wanted (or the study would not have been publicized had it not turned out the way they wanted).  Just like a study that showed mammograms were not effective in reducing cancer rates.  "Torture the numbers long enough, and they will say anything you want them to say!"

 

Testing a lot helps me tremendously and is the only way to learn how your body reacts to different foods and activities and medications.  I am for self-monitoring often 100%!!!!

 

If the insurance companies want to save money (did I say "if"??), I would much rather they change their coverage to the cheaper strips that are available.  That would be smart business and I've wondered why they haven't done this---politics, pressure, lobbying, influence of big companies???

 

I use Accu Chek Active strips and meter.  They cost almost half of what other types cost.  I think that would drive the cost of the expensive strips down in order to keep customers.  I would much prefer to use cheaper strips and test twice as often!!

 

If some companies can make strips for 40-50 cents each, I'm sure the big name companies can also.  Over $1 a strip is too much!  Maybe most people don't care because their insurance is paying for the strips, but it still hurts us all in the long-run as insurance companies keep raising their premiums and cutting their coverage.

I don't mean to be ornery, but look at the results. They speak for themselves. Self monitoring does not help people manage their diabetes. In fact, all the information in the world about type 2 does not help most people alter the course of their disease. In a very small number of people, education and the fear of complications will help change behavior and may (I do say "may"!) delay or ward off the disastrous complications of diabetes. Most people with type 2 are well aware of what their disease does to their body, but this does not makes little, if any, difference. It is just like dieting. Anyone who has been overweight knows more about the various diets and all the calorie, carb, fat counts of most foods, but dieting is still a failed prescription for the vast majority of folks.

 

I realize I am being a real you-know-what in the punch bowl here, but we have to face reality rather than what we wished were true. Does that mean you can give up and head for Krispy Kreme? No, of course not. We still have to try to do what we can for ourselves, but for most people, behavior changes do not last and even if they did, the disease can still progress. All I am saying is diabetes is a disease, and it may be that we have far less control over the progression and outcome than we think we do.

 

If you feel that self monitoring helps you, then by all means, continue, but it may be more of a placebo effect than any real benefit. As for insurance, my husband and I own an inexpensive meter that requires less expensive strips and pay for it ourselves. It doesn't cost us that much, and we can test when we want. After reading these studies, though, we may just abandon it altogether. When I have a bad reading, it depresses me terribly, but it does not seem to alter my behavior, and what I eat doesn't always seem to correlate with my results.

 

Just because a medical practice attains the status of dogma, does not make it true.