SMBG Fails to Improve Type 2 Diabetes Management

Recent research presented at the American Diabetes Association’s 77th Scientific Sessions showed that patients with type 2 diabetes who self-monitored blood glucose levels failed to improve glycemic control.

“The value of self-monitoring of blood glucose (SMBG) for patients with non–insulin-treated type 2 diabetes mellitus has been debated, yet over 75% perform regular SMBG,” study presenter Laura A Young, MD, PhD, and colleagues wrote in JAMA Internal Medicine. “Several trials showed significant benefit from SMBG on glycemic control, while others found no evidence of benefit. Our goal was to answer the following question: Is SMBG effective for people with non–insulin-treated type 2 diabetes mellitus in terms of improving either hemoglobin A^1C levels or health-related quality of life?”

The researchers conducted a pragmatic trial across 15 primary care practices, including 450 adults with type 2 diabetes who were not treated with insulin. The study participants were divided into three study groups, patients who received meters and test strips for once-daily SMBG, patients who conducted once-daily SMBG with automatic tailored messages delivered to their meters, and patients who performed no SMBG. The researchers reassessed patients at 1 year after randomization.  

The primary study outcomes included change in hemoglobin A^1C levels at baseline vs 1 year follow-up. Furthermore secondary outcomes included Problem Areas in Diabetes, Diabetes Symptoms Checklist, and Diabetes Empowerment Scale scores in order to evaluate self-efficacy. The researchers also monitored adverse events such as finger-stick infections and severe hypoglycemia. 

Additionally, the researcher noted that patient preference among the entire study cohort was 22% preferring not to self-monitor their blood glucose levels and 40% preferring to self-monitor. 

Study results showed that at 1 year their was no evidence that self-monitoring led to any statistically significant improvements in glycemic control. Data showed that there were also no improvements in health-related quality of life.

“Our findings suggest that in patients with non-insulin-treated type 2 diabetes, there were no clinically or statistically significant differences at one year in glycemic control or quality of life between patients who performed SMBG compared to those who did not perform SMBG,” Dr Young and colleagues wrote.

Furthermore, the researchers found that automatically tailored messaging has no effect on improving glycemic control.

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

The researchers suggested that more clinician involvement may be the key to improving self monitoring and self-control of glycemic levels. 

“Although designed with an eye toward the real-world clinical setting, our study team did not engage with the patients beyond the baseline visit,” they wrote. “Clinicians likewise had minimal interaction with the study team. Thus, we do not have data on what the clinicians did with the summary of blood glucose results. More active engagement of both patients and clinicians may have improved patient outcomes.”—David Costill