MedicalResearch.com Interview with:
Katrina Donahue MD, MPH
Professor, Director of Research, UNC Family Medicine. Co-Director,
North Carolina Newtork Consortium (NCNC).
Chapel Hill, NC
MedicalResearch.com: What is the background for this study?
Response: Type 2 diabetes is an epidemic affecting one in 11 people in the United States. For those treated with insulin, checking blood sugar with a finger stick at home is an accepted practice for monitoring the effects of insulin therapy.
However, the majority of patients with type 2 diabetes are not treated with insulin. These patients, too, are often recommended glucose monitoring, despite an ongoing debate about its effectiveness in controlling diabetes or improving how patients feel. Currently, 75 percent of non-insulin treated type 2 diabetes patients perform regular blood glucose testing at home, generally at the recommendation of a provider.
“The MONITOR Trial” is the first large pragmatic study examining glucose monitoring in the United States.
MedicalResearch.com: What are the main findings?
Response: This study compared three distinct groups of randomized patients: no blood sugar monitoring, once daily glucose monitoring, or enhanced once-daily glucose monitoring with an internet-delivered tailored message of encouragement or instruction.
At the end of the year-long trial, it was found that there was no difference in blood glucose across all three arms. Additionally, there were no significant differences in health-related quality of life. There were no notable differences in hypoglycemia (low blood sugar), hospitalizations, emergency room visits. Between programs, there was no difference in the number of individuals who had to start using insulin treatment to better control blood sugar levels. All in all, home finger stick blood tests did not prove any health advantage, even when the monitoring process was enhanced by technology.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Patients and providers should consider each unique situation as they determine whether home blood glucose monitoring is appropriate. However, the study’s 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. If patient and provider determine that home monitoring is not necessary, it could save the patient hundreds of finger sticks and hundreds of dollars every year, at least until insulin treatment is required.
It is Important to note that these results do not apply to those treating their diabetes with insulin.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
1) Future, studies should examine different patient populations to see if there are those who benefit more from testing than others do. Our study was not powered for sub groups, such as prior history of fingerstick blood glucose testing, duration of diabetes, or certain situations, such as the start of a medication or a change in dose.
2) At this point, the technology used in enhanced home-monitoring did not offer any health advantage. Future studies might examine how to best engage patients in controlling their blood sugar levels.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Young LA, Buse JB, Weaver MA, Vu MB, Mitchell CM, Blakeney T, Grimm K, Rees J, Niblock F, Donahue KE, for the Monitor Trial Group. Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes in Primary Care SettingsA Randomized Trial. JAMA Intern Med. Published online June 10, 2017. doi:10.1001/jamainternmed.2017.1233
Note: Content is Not intended as medical advice.
Please consult your health care provider regarding your specific medical condition and questions.