The Great Monitoring Debate
Few people question that self-monitoring of blood glucose (SMBG) is key to managing insulin-treated diabetes. But what if you don't take insulin?
Recently, a number of research studies have reported that SMBG does not by itself lower A1C (an estimate of average glucose over a 3-month period) in type 2 diabetes when patients are treated with oral medications or simply with diet and exercise. Although a number of other studies have shown SMBG to be beneficial, the "negative" studies have gotten most of the attention. And as a result, many doctors and insurance companies are questioning whether people not using insulin should perform SMBG. This is significant because insurance providers (both private companies and government agencies) ultimately determine whether, and to what degree, diabetes supplies are reimbursed.
In October 2008, a group of research scientists from around the world met in Amsterdam to discuss the new studies. The conference was sponsored by the International Diabetes Federation and the International SMBG Working Group. Participants included many of the same scientists whose research showed SMBG to be of little benefit in those not using insulin. I had the privilege of attending this conference and listening to the pros and cons of SMBG use. A key topic of discussion was the "external validity" of the studies. In other words, are the findings from randomized, controlled studies applicable to real-life situations?
Not surprisingly, it was agreed that the external validity of many of the studies, pro and con, was questionable, and that more research is needed to better understand the value of SMBG and how it can best be used.
Most important, the group also agreed that SMBG has the potential to improve diabetes outcomes and quality of life. But these benefits will be realized only when people with diabetes and their health care providers use SMBG results to:
- Enhance understanding of each person's unique response to medication, lifestyle changes, or both.
- Provide feedback to support behavioral shifts, such as immediately seeing the impact of changes in eating and physical activity on daily glucose control.
- Guide diabetes management and adjustments in meal plans, physical activity, and medications when glucose is too high or too low.
The message is clear: You cannot expect to improve your diabetes control simply by performing a test and looking at a number. You and your health care providers must be willing and able to use SMBG results to identify problems and make changes as needed. And althoughthe conference was about non-insulin-treated diabetes, this message applies to all people
SMBG is a valuable tool, but only when you use it to its full potential.