The Need to Test Strategies Based on Common Sense | Diabetes | JAMA Internal Medicine | JAMA Network
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Editor's Note
July 2017

The Need to Test Strategies Based on Common Sense

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 3Associate Editor, JAMA Internal Medicine
JAMA Intern Med. 2017;177(7):929. doi:10.1001/jamainternmed.2017.1251

“You have diabetes.”

In most care settings, this statement still triggers prescription of a glucometer and instruction on how to perform self-monitoring of blood glucose (SMBG). Every 3 months thereafter, patients’ glucose logs are reviewed and routine SMBG is encouraged, regardless of patients’ risk of hypoglycemia or severe hyperglycemia, because common sense tells us that patients who proactively manage and monitor their diabetes should achieve better outcomes. In this issue of JAMA Internal Medicine, Young and colleagues1 test this long-held belief, randomizing 450 patients with non–insulin-dependent type 2 diabetes to no SMBG, SMBG, and SMBG with enhanced patient feedback. At 1 year, there were no differences in glycemic control, health-related quality of life, or adverse events (including hypoglycemia frequency, health care utilization, or insulin initiation). Nearly 75% of patients engaged in routine SMBG prior to enrollment. These results suggest that we can safely advise patients to discontinue, as well as not initiate, SMBG.