Blood Glucose Self-Monitoring in Type 2 Diabetes Does Not Benefit Glycemic Control

In patients with non-insulin-treated type 2 diabetes (T2D), self-monitoring of blood glucose (SMBG) failed to improve 1-year glycemic control and health-related quality of life (HRQOL) compared with patients who did not perform SMBG, according to a study published in JAMA Internal Medicine.

The pragmatic, open-label, randomized Monitor Trial (ClinicalTrials.gov identifier: NCT02033499) was conducted throughout 15 primary care practices in central North Carolina and included 450 patients with non-insulin-treated T2D.

Patients were at least 30 years of age (mean, 61 years), had a primary care physician at a participating practice, had hemoglobin A1c (HbA1c) levels greater than 6.5% but less than 9.5% within 6 months of screening, and were willing to comply with the results of random assignment into a study group. Demographic and clinical characteristics were comparable in both groups.

Overall, 92.9% of patients finished the final visit.

HbA1c levels and HRQOL at 52 weeks served as co-primary outcomes. The 3 SMBG approaches assessed were no SMBG (n=152); once-daily SMBG (n=150); and once-daily SMBG with enhanced patient feedback (n=148), which featured automatic tailored messages delivered via the meter.

The researchers reported no significant differences in HbA1c levels across the 3 groups (P =.74). Specifically, the estimated adjusted mean HbA1c difference for SMBG with messaging vs no SMBG was −0.09% (95% CI, −0.31% to 0.14%), and for SMBG vs no SMBG it was −0.05% (95% CI, −0.27% to 0.17%).

In addition, there were no significant differences between the study groups in terms of HRQOL and key adverse events, including hypoglycemia frequency, health care utilization, and insulin initiation.

“Incorporating technology into self-management activities has been touted as potentially transformative for patients, and to date some smaller studies support this notion. However, our findings do not,” the researchers wrote. “It is possible that the enhancement of SMBG with one-way messaging back to the patient does not adequately engage patients.”

The researchers added that as a result of their findings, glucose monitoring in patients with non-insulin-treated T2D should not be routine.

Disclosures: The researchers report several financial disclosures with pharmaceutical and device manufacturers.

Reference

Young LA, Buse JB, Weaver MA, et al; for the Monitor Trial Group. Glucose self-monitoring in non-insulin-treated patients with type 2 diabetes in primary care settings: A randomized trial [published online June 10, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.1233