Is Home Finger-stick Testing Beneficial for Diabetes Patients Not on Insulin?

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June 15th, 2017

CHAPEL HILL, NC — Physicians say it so often to their diabetes patients, it almost has become reflexive: “Be sure to test your blood sugar.”

Now, a new study in JAMA Internal Medicine questions that advice and suggests finger-stick blood sugar testing might not be that beneficial for diabetes patients who aren’t on insulin.

In the MONITOR Trial, University of North Carolina School of Medicine-led researchers suggested that neither glucose control nor quality of life is improved by frequent home finger-stick testing.

"Our study results have the potential to transform current clinical practice for patients and their providers by placing a spotlight on the perennial question, 'to test or not to test?'" explained senior study author Katrina Donahue, MD, MPH, professor and director of research at UNC Family Medicine.

For the randomized trial, 450 patients were assigned to one of three groups:

no blood glucose monitoring at all;
once daily glucose monitoring; or
enhanced once-daily glucose monitoring with encouragement and/or instruction via the internet.

After a year, results indicate no significant differences in blood glucose control, hypoglycemia, hospitalizations, ED visits, or health-related quality of life when the three groups were compared.

The study also found that diabetes patients who didn’t test their blood sugar were no more likely to need insulin treatment than those who did.

"Of course, patients and providers have to consider each unique situation as they determine whether home blood glucose monitoring is appropriate," Donahue said. "But the study's null results suggest that self-monitoring of blood glucose in non-insulin-treated type 2 diabetes has limited utility. For the majority, the costs may outweigh the benefits."

Yet, 75% of type 2 diabetes patients are advised to regularly check their blood glucose at home, even though the overwhelming majority don’t use insulin, according to background information in the article.

While proponents of blood glucose testing tout the influence of glucose level testing on improving diet and awareness, study authors suggested that small clinical trials testing that hypothesis have shown mixed results. They also pointed to the financial cost of daily testing, as well as the inconvenience and discomfort.

"There has been a lack of consensus, not just in the United States, but worldwide," explained first author Laura Young, MD, PhD. "The lack of standard guidelines makes it all the more difficult for patients, who are already struggling to manage a chronic condition. And at the end of the day, patients have to make a choice.”