Should Type 2s Test Their Blood Sugar?
In the past several years, some reports have been published saying that self-testing of blood glucose (BG) by people with type 2 diabetes is useless, a waste of money, and simply increases rates of depression.
Needless to say, there were loud outcries by many of us with type 2 who know how useful self-testing can be. Without testing, how would we ever know which foods made our BG levels go up the most? How would we know if exercise was beneficial or not?
We pointed out that these studies involved telling people with type 2 diabetes to test their blood sugar, without much education on how to modify their lifestyles or ask for medication changes on the basis of the results. No wonder the studies showed no benefit! It is, in fact, a waste of time and money to test your BG if you don't know what to do with the numbers you get except to write them down on a sheet of paper and show them to a doctor who is too busy to do much with the results.
Despite the ridiculousness of the studies, many of us were worried that insurance providers would cite them as a reason to stop paying for test strips for people with type 2.
Needless to say, no one listened to us patients. In the medical world, nothing is taken seriously until some group of people with a lot of letters after their names gets funding and does a study and then publishes the results.
But now a new study has been published here, and a group of diabetes professionals has discussed the results in the journal The Diabetes Educator, which is likely to be read by most certified diabetes educators. In the cited study, the difference in hemoglobin A1c in the SMBG (self-monitoring of blood glucose) group was small (6.95 instead of 7.2) but significant.
The Diabetes Educator article notes that the International Diabetes Federation has concluded that "simply recommending SMBG to patients without instructions for testing or use [of] results in [is] a waste of time, money, and resources." That's what we patients said.
The Diabetes Educator authors wrote, "Most of the current trials of SMBG in type 2 diabetes failed to incorporate the use of SMBG data by the health care team for aiding therapeutic decisions into the study protocol, which is probably why many of these studies showed SMBG to have little or no benefit in improving clinical outcomes."
But the Diabetes Educator authors noted that "a recent report from the International Diabetes Federation recommends SMBG use in this population if it is used to educate/motivate individuals and/or monitor and adjust therapy. Healthcare providers must develop strategies to utilize SMBG in ways that address these criteria."
Most of us would agree.
"Paired-meal SMBG [measuring BG before and after a meal] may be one of the most useful tools for achieving adherence to a nutrition regimen," wrote the Diabetes Educator authors.
To be fair, one must note that the Diabetes Educator article was supported by Roche Diagnostics, which obviously has an interest in promoting increased SMBG.
Nevertheless, the conclusions are what many of us patients would consider self-evident, and at least an opinion in contrast to that of the researchers who said SMBG is a waste of money is getting some attention. The story was picked up by Science Daily, EurekAlert! and other popular science news media, and hence should get wide attention.
In the long run, self-testing along with education about what to do with the results is one of the best way for our medical system to save money.
When I was using a continuous glucose monitor, my A1c decreased by a full point. These gizmos are probably still too expensive for type 2s (they're lifesavers for people with type 1, especially toddlers who can't explain how they feel) for anything but preliminary testing to find out which foods you can eat and how exercise affects your BG levels.
I think every type 2 should be provided with a continuous monitor for the first 2 or 3 months after diagnosis. Then they could switch to test strips and intensive testing for the next year, and finally to testing only for new foods, sickness, new lifestyle patterns, or when they felt something was not right.
Test strips are much cheaper than dialysis.