Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin

Malanda, U.L.; Welschen, L.M.C.; Riphagen, Ingrid I.; Dekker, Joost; Nijpels, Giel; Bot, S.D.M.

doi:10.1002/14651858.cd005060.pub3

Cited by 242 publications

(241 citation statements)

References 63 publications

(3 reference statements)

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“…There is a common misperception that BGM is an expensive, complex undertaking with limited benefit, leading some to assert that BGM is not warranted in patients with T2DM (32)(33)(34)(35). The studies that appear to give negative results in patients with T2DM have been criticized for serious experimental design flaws (28).…”

Section: History Of Gm In Diabetesmentioning

confidence: 99%

“…Several randomized trials and literature reviews have called into question the clinical utility and cost-effectiveness of routine BGM in patients with T2DM who are not receiving insulin therapy (32,33,35,95,96). A key consideration is that BGM, used alone, does not lower blood glucose levels.…”

Section: T2dm Adult Patients With T2dmmentioning

confidence: 99%

“…Daily BGM has not been shown to be effective in patients on diet/lifestyle therapy who are at low risk for hypoglycemia (28,33,35,94). However, structured testing may help patients improve their understanding of the effectiveness of medical nutrition therapy (MNT) and lifestyle management.…”

Section: Gm In Patients With T2dm On Diet/lifestyle Therapy Onlymentioning

confidence: 99%

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American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

et al. 2016

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Section: History Of Gm In Diabetesmentioning

confidence: 99%

Section: T2dm Adult Patients With T2dmmentioning

confidence: 99%

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American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

et al. 2016

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“…However, partly due to the increase in medical cost, higher frequency SMBG often is not recommended, especially for insulin-naïve diabetes patients (Tunis et al, 2010b;Cameron et al, 2010a). In addition, lower frequency SMBG, for example once daily, may not be useful for glycemic control (Malanda et al, 2012;Farmer ete al., 2012;Clar et al, 2010). Recently it was reported that structured testing can have a beneficial effect on glycemic control (Polonsky et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, no consensus on improvement of glycemic control by SMBG has been obtained in insulin-naïve patients, even though evidence of the general benefits of SMBG has been increasing in the last decade. Previous studies show that the effects of simply measuring blood glucose in insulin-naïve patients are minimal (St John et al, 2010;Farmer et al, 2012;Malanda et al, 2012). However, when individuals with insulin-naïve type 2 diabetes perform SMBG frequently, glycemic control has been shown to be improved (Harashima et al, 2013;Elgart et al, 2016) as also in type 1 (Miller et al, 2013) and insulin-treated type 2 diabetes (Elgart et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Effects of structured testing versus routine testing of blood glucose in diabetes self-management: A randomized controlled trial

Nishimura

Harashima

Fujita

et al. 2017

Journal of Diabetes and its Complications

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Aims:To compare the effects of structured and routine testing regimens used in self-monitoring of blood glucose (SMBG) on glycemic control and diabetes self-management in insulin-naïve type 2 diabetes patients. Methods:Sixty-two outpatients with insulin-naïve type 2 diabetes were randomly allocated into two less-frequent SMBG usage groups: a structured testing group (STG) and a routine testing group (RTG). Subjects in STG measured 7-points on SMBG for 3 consecutive days once every two months without daily testing; subjects in RTG measured SMBG 3 times each week before breakfast on Monday and Friday and before dinner on Wednesday. The primary endpoint was HbA1c reduction. The secondary endpoints were change in body weight, blood pressure, treatment change, and self-management performance change. Results:HbA1c levels were significantly decreased by 0.32% (3.50 mmol/mol) in STG, partly because physicians changed medications more actively. In contrast, body weight and systolic/diastolic blood pressure were significantly reduced by 0.94 kg and 6.8/4.7 mmHg, respectively, in RTG, possibly related to the increased diet and exercise score in RTG. Conclusions:Structured testing without daily testing is beneficial for glycemic control; routine testing 3 times a week is more helpful for daily self-management. In low SMBG frequency usage, these two regimens can be utilized according to individual diabetic conditions.

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Dual Use of Department of Veterans Affairs and Medicare Benefits and Use of Test Strips in Veterans With Type 2 Diabetes Mellitus

et al. 2015

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IMPORTANCE Self-monitoring of blood glucose is a costly component of care for diabetes mellitus, with unclear benefits for patients not taking insulin. Veterans with dual Department of Veterans Affairs (VA) and Medicare benefits have access to test strips through both systems, raising the potential for overuse.OBJECTIVES To examine the patterns of test strip receipt among older veterans with diabetes and determine whether receipt of strips from dual health care systems is associated with overuse. DESIGN, SETTING, AND PARTICIPANTSWe performed a cross-sectional, retrospective cohort study using national VA administrative data linked to Medicare Parts A, B, and D claims for fiscal years 2008 and 2009. A total of 363 996 community-dwelling veterans 65 years or older with diabetes who used the VA health care system and received test strips in fiscal year 2009 were included in the study.EXPOSURES Receipt of test strips from the VA only, Medicare only, or both the VA and Medicare; covariates included sociodemographics, comorbidity, diabetes complications, and hemoglobin A 1c level. MAIN OUTCOMES AND MEASURESQuantity of test strips dispensed and overuse of test strips, defined as more than 1 strip per day (>365 strips per year) among those taking no diabetes medications, oral diabetes medications alone, or long-acting insulin without short-acting insulin or more than 4 strips per day (>1460 strips per year) among those taking short-acting insulin.RESULTS Overall, 260 688 older veterans (71.6%) with diabetes received strips from the VA only, 82 826 (22.8%) from Medicare only, and 20 482 (5.6%) from the VA and Medicare. Veterans receiving strips from both the VA and Medicare received more strips (median, 600; interquartile range [IQR], 350-1000) than the Medicare only (median, 400; IQR, 200-700) and VA only (median, 200; IQR, 100-500) groups (P < .001) and had substantially greater odds of overuse than the VA only group (55.4% vs 15.8%) (adjusted odds ratio [OR], 16.3; 95% CI, 14.6-18.1 for no medications; 55.3% vs 6.0%; OR, 19.8; 95% CI, 18.9-20.8 for oral medications; 87.4% vs 65.5%; OR, 3.69; 95% CI, 3.30-4.14 for long-acting insulin; and 32.8% vs 13.5%; OR, 3.24; 95% CI, 3.05-3.45 for short-acting insulin). Patterns were similar when using more conservative thresholds of overuse. CONCLUSIONS AND RELEVANCEVeterans who receive glucose test strips through both the VA and Medicare use more strips and are more likely to potentially overuse strips. These results illustrate the profound importance of understanding dual VA and Medicare coverage and are emblematic of waste and inefficiency.

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Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin

Cited by 242 publications

References 63 publications

American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

Effects of structured testing versus routine testing of blood glucose in diabetes self-management: A randomized controlled trial

Dual Use of Department of Veterans Affairs and Medicare Benefits and Use of Test Strips in Veterans With Type 2 Diabetes Mellitus

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