Is self-monitoring blood glucose levels effective for people with non–insulin-treated type 2 diabetes in terms of improving either hemoglobin A1c levels or health-related quality of life (HRQOL) in primary care practice?
In this pragmatic randomized clinical trial that included 450 patients randomized to 1 of 3 groups: no self-monitoring of blood glucose (SMBG), once-daily SMBG, and once-daily SMBG with enhanced patient feedback. There were no significant differences in glycemic control across all groups, nor were there significant differences found in HRQOL.
Routine self-monitoring of blood glucose levels does not significantly improve hemoglobin A1c levels or HRQOL for most patients with non–insulin-treated type 2 diabetes; patients and clinicians should consider the specifics of each clinical situation as they decide whether to test or not to test.
The value of self-monitoring of blood glucose (SMBG) levels in patients with non–insulin-treated type 2 diabetes has been debated.
To compare 3 approaches of SMBG for effects on hemoglobin A1c levels and health-related quality of life (HRQOL) among people with non–insulin-treated type 2 diabetes in primary care practice.
Design, Setting, and Participants
The Monitor Trial study was a pragmatic, open-label randomized trial conducted in 15 primary care practices in central North Carolina. Participants were randomized between January 2014 and July 2015. Eligible patients with type 2 non–insulin-treated diabetes were: older than 30 years, established with a primary care physician at a participating practice, had glycemic control (hemoglobin A1c) levels higher than 6.5% but lower than 9.5% within the 6 months preceding screening, as obtained from the electronic medical record, and willing to comply with the results of random assignment into a study group. Of the 1032 assessed for eligibility, 450 were randomized.
No SMBG, once-daily SMBG, and once-daily SMBG with enhanced patient feedback including automatic tailored messages delivered via the meter.
Main Outcomes and Measures
Coprimary outcomes included hemoglobin A1c levels and HRQOL at 52 weeks.
A total of 450 patients were randomized and 418 (92.9%) completed the final visit. There were no significant differences in hemoglobin A1c levels across all 3 groups (P = .74; estimated adjusted mean hemoglobin A1c difference, SMBG with messaging vs no SMBG, −0.09%; 95% CI, −0.31% to 0.14%; SMBG vs no SMBG, −0.05%; 95% CI, −0.27% to 0.17%). There were also no significant differences found in HRQOL. There were no notable differences in key adverse events including hypoglycemia frequency, health care utilization, or insulin initiation.
Conclusions and Relevance
In patients with non–insulin-treated type 2 diabetes, we observed no clinically or statistically significant differences at 1 year in glycemic control or HRQOL between patients who performed SMBG compared with those who did not perform SMBG. The addition of this type of tailored feedback provided through messaging via a meter did not provide any advantage in glycemic control.
clinicaltrials.gov Identifier: NCT02033499
Young LA, Buse JB, Weaver MA, Vu MB, Mitchell CM, Blakeney T, Grimm K, Rees J, Niblock F, Donahue KE, for the Monitor Trial Group. Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes in Primary Care SettingsA Randomized Trial. JAMA Intern Med. 2017;177(7):920–929. doi:10.1001/jamainternmed.2017.1233