SMBG for T2: A help or a hindrance?

Not too surprisingly, they also found that SMBG (with or without additional training in incorporating the results into self care) was associated with higher costs. They mention that the higher costs of visits for the more intensive self monitoring group than for standardized usual care may relate to the observed changes in health status between the groups, with a need to seek further support or advice, or may be a chance finding.  And they concluded that with "no clinically significant differences in other outcomes, self monitoring of blood glucose is unlikely to be cost effective in addition to standardized usual care." And they add that SMBG "should not be recommended for routine use."

What are we to conclude from these two recent studies? Both indicated that it's possible to improve diabetic control in people with T2DM who are not taking insulin without using SMBG. Both implied that there may be some detrimental effect on patient's psychologic status (based on questionaires, not on actual outcomes), and unsurprisingly there was a documented detrimental effect on pocketbooks: SMBG cost more than not doing monitoring.

Two very important points to bear in mind:

(1) Neither study looked at people with T1DM, women during pregnancy, or T2DM patients who are on insulin. The results must not be generalized to these other patients.

(2) Although these studies do show that if people with T2DM who are not taking insulin can be controlled without SMBG, it requires that such folks  have their A1C levels measured every three months, and be seen every three months and have their diabetes program adjusted based on those A1C levels.

And one final point that I'd like to address specifically to insurance companies: Before anyone from any insurance company who might be reading these studies decides against reimbursing for SMBG for T2DM patients not taking insulin, they should also remember to insist that these patients get A1C levels checked every three months, and be seen by their physicians every three months.