Diabetes and SMBG

From the NEJM Journal Watch June 29, 2017. General consensus of the study is that SMBG is less than ideally effective in glycemic control and quality of life. It seems to me that result is not a measure of the effectiveness but of the ineffectiveness of not doing so. It would be a little more helpful to do a study of those who actually maintain the practice.

That said, any personal trainer following standard established guidelines will insist that you monitor you blood sugar as a requisite for training. Hypoglycemia is common with diabetics who begin an effective exercise program and may occur up to 24 after an exercise session. Hypoglycemia, frightening at best, can be fatal. I require all those who have been diagnosed as diabetic or pre-diabetic to SMBG and carry some form of glucose recovery (e.g., glucose tablets, fruit juice, a fast acting carb).

Is Glucose Self-Monitoring Worthwhile in Non–Insulin-Treated Diabetes?

Bruce Soloway, MD reviewing Young LA et al. JAMA Intern Med 2017 Jun 10.

1. Bruce Soloway, MD

In a study with limitations, self-monitoring did not improve outcomes.

1. Bruce Soloway, MD

Most non–insulin-treated patients with type 2 diabetes perform self-monitoring of blood glucose (SMBG), but whether this practice improves glycemic control or quality of life is unclear. Researchers in North Carolina randomized 450 non–insulin-treated type 2 diabetics (glycosylated hemoglobin [HbA_1c] level, 6.5%−9.5% within 6 months preceding randomization) to no SMBG, once-daily SMBG, or once-daily SMBG plus automated algorithm-derived messages designed to educate and motivate patients. Primary care providers received reports of SMBG data and continued routine management of their patients' diabetes. HbA_1c and health-related quality of life were measured at baseline and 1 year later. Otherwise, the study team did not contact the patients or clinicians; interim HbA_1c values were retrieved from patients' electronic medical records.

Among patients randomized to SMBG, adherence to daily testing decreased from about 90% at baseline to about 55% at 1 year, with less-frequent testing in patients who received automated messages than in those who did not. Mean HbA_1c was significantly lower in both SMBG groups than in the no-SMBG group (mean difference, −0.33%) at 6 months. However, at 1 year, groups did not differ significantly in HbA_1c levels or health-related quality of life.

Comment

Without consistent reinforcement, adherence to SMBG eroded rapidly; the authors suggest that this might have contributed to the disappearance of SMBG's early effect on HbA_1c. In my experience, SMBG can be helpful for some non−insulin-treated patients, by providing daily reinforcement of lifestyle choices that enhance glycemic control. More rigorous studies could help us identify those patients with type 2 diabetes for whom SMBG might add measurable value.