The Need to Test Strategies Based on Common Sense

“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.

This important study was funded by the Patient-Centered Outcomes Research Institute and illustrates how patient-centered clinical research can address clinical problems. The surprising findings make us question the current seemingly common sense–based strategy to encourage routine SMBG. These findings and others² support the Choosing Wisely³ recommendations of the Society of General Internal Medicine and Endocrine Society that discourage frequent blood glucose monitoring among patients with type 2 diabetes. Routine SMBG merits a “less is more” designation because there were no clear benefits accrued, which leaves only possible harms.

Corresponding Author: Elaine C. Khoong, MD, MS, Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, 1M, San Francisco, CA 94110 (elaine.khoong@ucsf.edu).

Conflict of Interest Disclosures: Dr Ross receives research funding through Yale University from Medtronic Inc and the US Food and Drug Administration (FDA) to study issues in postmarket medical device surveillance, from the FDA to establish the Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation, from Johnson & Johnson to develop methods for clinical trial data sharing, from the Centers for Medicare and Medicaid Services to develop measures for public reporting hospital and physician quality, from the Blue Cross Blue Shield Association to advance premarket evidence generation for medical products, and from the Laura and John Arnold Foundation to support the Collaboration on Research Integrity and Transparency at Yale University. No other disclosures are reported.