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Research Letter
Less Is More
December 10, 2018

Assessment of Self-monitoring of Blood Glucose in Individuals With Type 2 Diabetes Not Using Insulin

Author Affiliations
  • 1Department of Internal Medicine, University of Michigan, Ann Arbor
  • 2Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor
  • 3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
JAMA Intern Med. Published online December 10, 2018. doi:10.1001/jamainternmed.2018.5700

Low-value care worsens patient-centered outcomes and imparts a negative economic effect, which has prompted the Choosing Wisely campaign to promote a national dialogue on the judicious use of services that are deemed to be nonbeneficial. One recommendation is “avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia.”1 This recommendation is based on robust evidence, including a Cochrane review of 12 randomized clinical trials with more than 3000 patients, showing no statistical difference between patients who do not self-monitor their blood glucose multiple times per day and those who do self-monitor their blood glucose multiple times per day in glycemic control, nor evidence of effects on health-related quality of life, patient satisfaction, or decreased number of hypoglycemic episodes.2 The aim of this study was to quantify the rate of use and cost of self-monitoring blood glucose supplies that are potentially used inappropriately, specifically focusing on test strips, the most costly supply for regular blood glucose monitoring.

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    2 Comments for this article
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    Glucose Testing Isn't Just About Hypoglycemia
    Tina Tomsen, M.D. | Anchorage Women's Clinic
    As a private practitioner who refers patients with prediabetes to an excellent nutritionist to identify dietary and exercise habits they can correct in order to lower their HgbA1C's and reduce the chance of the consequences of diabetes/ prediabetes over their lifetime, I find your letter (essentially complaining about the cost to insurance companies of the test strips) misplacing the blame.

    While glucometers are now cheap and readily available, the test strips are sold at an outrageous price. What I would like to see is whether those who use more test strips were able to effect lower
    HgbA1C's as compared to non-testers. Perhaps we should be using MORE test strips, and they ought to be cheaper.
    CONFLICT OF INTEREST: None Reported
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    Dangerous Too
    Sarosh Ahmed Khan, MBBS; MD; FACP | Director, Naseem Medical Center, Srinagar
    Unnecessary testing not only is costly but it leads to bad management. Many doctors advise  patients to monitor their sugar levels using a glucometer. Common advice is to increase or decrease insulin by 2-4 units if the blood glucose levels are 'high' or 'low' respectively. There are so many factors which make the glucose level fluctuate. Reacting to each and every change is not advisable.  Many patients develop hypoglycemia due to this practice. That is dangerous.

    It should always be the doctor to make the decision about titrating the insulin dose.
    CONFLICT OF INTEREST: None Reported
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