What Does UNC Study Mean for Future of Self Blood Glucose Monitoring?

A Harvard expert says there are still times when finger stick tests make sense, but payers may question why they should pay for supplies.

Experts are still reacting to results from a randomized clinical trial that turned standard care for type 2 diabetes (T2D) on its head: could it be possible that patients not using insulin don’t need to take their blood sugar every day?

Findings presented during last month’s meeting of the American Diabetes Association (ADA), and published in the July issue of JAMA Internal Medicine, suggest it’s true. The study from the University of North Carolina, led by Laura A. Young, MD, PhD, for the Monitor Trial Group,1 found that patients with T2D who did regular finger stick tests to check their blood sugar had no better glycemic control or quality of life after a year than patients who didn’t test at all.

In the study, 450 patients were randomized; 418 completed the trial. There were 3 groups: 1 group did not test, 1 group tested daily, and 1 group tested with enhanced feedback. There were no significant differences in glycated hemoglobin (A1C) across the groups: self-monitoring with messaging versus self-monitoring without, -0.09%; self-monitoring versus no self-monitoring, 0.05%. The study did not find any significant differences in scores for quality of life or in key adverse events, such as frequent incidents of hypoglycemia, use of healthcare, or starting insulin.

It’s important to note these were all patients being treated without insulin, so their blood sugar levels perhaps did not require as much monitoring as patients with more advanced disease. However, the findings have huge implications for diabetes care and for payers, who may question whether it makes sense to pay for glucose meters and testing supplies for these patients.

It’s worth noting the study was funded by PCORI, the Patient-Centered Outcomes-Research Institute, a non-governmental entity created by the Affordable Care Act that could actually save Medicare and Medicaid money if this recommendation takes hold among payers (it’s already been endorsed by the Endocrine Society under the Choosing Wisely initiative, according to an Editor’s Note that appeared with the study).2

Does this mean T2D patients not taking insulin should never do finger stick tests? Probably not, argues Harvard’s Robert H. Shmerling, MD, in a commentary published this week.3

For starters, Shmerling says more studies are needed to confirm the findings. Second, there will still be times when self-monitoring makes sense. He suggests several:

  • When a person with T2D has an infection
  • When a patient changes medication, or adjusts the dose
  • When the T2D patient loses several pounds
  • If the T2D patient starts taking insulin

Writes Shmerling, “We’ll need more studies and longer term studies to identify people which people with type 2 diabetes will benefit most from home monitoring and when it’s just not worth the effort.”

References

1. Young LA, Buse JB, Weaver MA, et al for the Monitor Trial Group. Glucose self-monitoring in non-insulin treated patients with type 2 diabetes in primary care settings: a randomized trial. JAMA Intern Med. 2017; 177(7): 920-929. doi: 10.1001/jamainternmed.2017.1233.

2. Khoong EC, Ross JS. The need to test strategies based on common sense. JAMA Intern Med. 2017; 177(7): 929. doi:10.1001/jamainternmed.2017.1251

3. Shmerling RH. Type 2 diabetes: value of home blood-sugar monitoring unclear. Harvard Health Publications. Harvard Medical School website. http://www.health.harvard.edu/blog/type-2-diabetes-value-home-blood-sugar-monitoring-unclear-2017072411989. Published July 24, 2017.