Furthermore, more-intensive self-monitoring had a significantly negative effect on quality of life.
Routine self-monitoring of glucose levels is promoted as a means of improving glycemic control among people with type 2 diabetes. Presumably, patients who are aware of their glucose level will more likely achieve glycemic control. However, in a recent trial (JW Jul 3 2007), no differences were found in hemoglobin A1c levels after 12 months among 453 non–insulin-treated type 2 diabetics who were randomized to usual care, to additional self-monitoring with advice to contact their physician to interpret the results (less-intensive monitoring), or to additional self-monitoring with training in interpreting and responding to the results (more-intensive monitoring). In addition, self-monitoring is expensive. Using data from the same trial, investigators determined the cost-effectiveness and the effect on quality of life of self-monitoring.
The cost of usual care was significantly lower than costs of less-intensive and more-intensive self-monitoring of glucose. Furthermore, more-intensive self-monitoring had a significantly negative effect on quality of life.
Comment: In patients with non–insulin-treated type 2 diabetes, less- and more-intensive self-monitoring of glucose do not improve glycemic control and increase costs, and more-intensive monitoring reduces quality of life. These findings argue against routine self-monitoring for these patients. However, intermittent home monitoring to address specific problems (e.g., to detect hypoglycemia or to determine quickly whether a patient is responding to a newly added oral agent) may be useful. In addition, these findings do not apply to patients with insulin-treated type 2 diabetes or with type 1 diabetes.
— Paul S. Mueller, MD, MPH, FACP
Published in Journal Watch General Medicine May 22, 2008