Diabetes Forecast

Self-Monitoring and Type 2 Diabetes

By Erika Gebel, PhD , ,

The scientific evidence has been mixed about the value of self-monitoring blood glucose for people with diabetes who don't take insulin. A review of 12 studies by Uriëll Malanda, MD, of the National Institute for Public Health and the Environment in the Netherlands showed a variety of outcomes, but as a whole, the data suggested that the drop in A1C results was tiny. "I think it's time to accept the fact that self-monitoring, as most people perform it, isn't effective," says Malanda. "There's no bang for your buck."

Malanda says the studies showed that self-monitoring was costly and potentially unhelpful in improving glucose control. "Patients with type 2 who are not using insulin don't have any tools to change their glucose levels immediately," says Malanda. But he concedes that his conclusions are only as good as the studies that he analyzed.

Data-Mining Tips

1. Use your numbers to take action. "If you file the numbers away and don't interact with them, they're a waste of time," says diabetes educator Mary Austin, MA, RD, CDE.
2. Your health plan may offer just one strip a day—skip a day periodically to save strips for multiple daily tests on occasion. "It's OK if you run out [of strips] so long as you got some valuable testing," Austin says. Testing before and after meals, for example, can reveal glucose spikes.
3. If you're high after a small meal, that may mean you need either more or different medication. If you're high after a large meal, try to tweak your eating habits. You can help yourself by, say, having one less slice of pizza, says Austin.
4. If pre-breakfast test results are running high, check blood glucose at bedtime and then the next morning on a few different days. If results are higher in the morning than at bedtime, uncontrolled glucose production by the liver may be to blame, not what you've eaten for dinner or a snack. Medication or other approaches may be helpful.
5. Define why you're testing. If a provider fails to look at the numbers and discuss changes, ask if you need to continue self-monitoring. If the answer is yes, ask what you should be doing in response to the numbers.

Robert Vigersky, MD, of the Walter Reed National Military Medical Center says "one of the reasons [blood glucose testing in type 2] is controversial is because the recommendations are made based on studies that really were poorly designed or didn't have a sufficient number of patients." Participants often were given meters and sent on their way, with no information on how to use the measurements, he says.

Vigersky says that a "structured approach" to self-monitoring has more promise. People with type 2 are shown how to improve glucose results with lifestyle changes. Plus, physicians take patients' readings into account when writing prescriptions and giving advice.

A 2010 study in the Journal of Diabetes examined a structured approach. People not taking insulin were advised to test six times a day, three days a week, and doctors were given a specific way to translate those readings into medical decisions. After one year, people who self-monitored lowered their A1Cs from 6.6 percent to 6.1 percent while those who received standard care didn't budge their A1Cs. Glucose testers also lost some weight.



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