In times of short health care budgets, reimbursement for self-monitoring of blood glucose (SMBG) in diabetes patients without insulin treatment is subject to debate. The Structured Testing Program (STeP) trial found a positive correlation of test frequency and improved hemoglobin A1c (HbA1c) levels in poorly controlled type 2 diabetes patients not treated with insulin.
Methods:
A structured literature search for other clinical studies reporting on SMBG frequency was performed.
Results:
There is scarce evidence: Three trials, including STeP, noted a significant and relevant correlation between testing frequency and improved HbA1c levels (FA effect), whereas two studies did not. The comparability between the identified studies is problematic.
Conclusion:
Future research should consider correlations between testing frequency and level of glycemic control. More emphasis should be placed on a structured approach to use SMBG and to address adherence to testing and therapy.
CameronCCoyleDUrEKlarenbachS. Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin. CMAJ.2010;182 (1): 28–34.
2.
KolbHKempfKMartinSStumvollMLandgrafR. On what evidence-base do we recommend self-monitoring of blood glucose?. Diabetes Res Clin Pract.2010;87 (2): 150–6.
3.
HolmanRRPaulSKBethelMAMatthewsDRNeilHA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med.2008;359 (15): 1577–89.
4.
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet.1998;352 (9131): 837–53.
5.
NyenweEAJerkinsTWUmpierrezGEKitabchiAE. Management of type 2 diabetes: Evolving strategies for the treatment of patients with type 2 diabetes. Metabolism.2011;60 (1): 1–23.
6.
American Diabetes Association. Standards of medical care in diabetes–2011. Diabetes Care.2011;34Suppl 1: S11–61
7.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med.1993;329 (14): 977–86.
8.
LeeseGPWangJBroomhallJKellyPMarsdenAMorrisonWFrierBMMorrisAD; DARTS/MEMO Collaboration. Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: A population-based study of health service resource use. Diabetes Care.2003;26 (4): 1176–80.
9.
PolonskyWHFisherLSchikmanCHHinnenDAParkinCGJelsovskyZPetersenBSchweitzerMWagnerRS. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: Results from the Structured Testing Program study. Diabetes Care.2011;34 (2): 262–7.
10.
HirschIB. Home blood glucose monitoring in type 2 diabetes: Broken health care system undermines study's impact. Diabetes Care.2011;34 (2): 527–8.
11.
MastPWFisherLParkinCJelsovskyZSchweitzerMWagnerR. Structured blood glucose monitoring reduces HbA1c levels and annual test strip consumption in poorly controlled, non-insulin treated type 2 diabetes: Results from the STeP Study. Diabetologia.2010;53Suppl 1: S423–4
12.
BonomoKDe SalveAFioraEMularoniEMassuccoPPoyPPomeroACavalotFAnfossiGTrovatiM. Evaluation of a simple policy for pre- and post-prandial blood glucose self-monitoring in people with type 2 diabetes not on insulin. Diabetes Res Clin Pract.2010;87 (2): 246–51.
13.
KarterAJParkerMMMoffetHHSpenceMMChanJEttnerSLSelbyJV. Longitudinal study of new and prevalent use of self-monitoring of blood glucose. Diabetes Care.2006;29 (8): 1757–63.
14.
SchüttMKernWKrauseUBuschPDappAGrziwotzRMayerIRosenbauerJWagnerCZimmermannAKernerWHollRW; DPV Initiative. Is the frequency of self-monitoring of blood glucose related to long-term metabolic control? Multicenter analysis including 24,500 patients from 191 centers in Germany and Austria. Exp Clin Endocrinol Diabetes.2006;114 (7): 384–8.
15.
HarrisMI; National Health and Nutrition Examination Survey (NHANES III). Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Diabetes Care.2001;24 (6): 979–82.
16.
ScherbaumWAOhmannCAbholzHHDraganoNLankischM. Effect of the frequency of self-monitoring blood glucose in patients with type 2 diabetes treated with oral antidiabetic drugs-a multi-centre, randomized controlled trial. PloS One.2008;3 (8): e3087.
17.
Department of Health and Human Services. Review of Medicare claims for home blood-glucose test strips and lancets: Durable medical equipment Medicare administrative contractor for Jurisdiction A. U.S. Department of Health and Human Services; 2010. http://oig.hhs.gov/oas/reports/region9/90800043.pdf.
18.
PolonskyWHFisherLSchikmanCHHinnenDAParkinCGJelsovskyZAxel-SchweitzerMPetersenBWagnerRS. A structured self-monitoring of blood glucose approach in type 2 diabetes encourages more frequent, intensive, and effective physician interventions: Results from the STeP study. Diabetes Technol Ther.2011;13 (8): 797–802.
19.
Pimazoni-NettoARodbardDZanellaMT; Diabetes Education and Control Group. Rapid improvement of glycemic control in type 2 diabetes using weekly intensive multifactorial interventions: Structured glucose monitoring, patient education, and adjustment of therapy-a randomized controlled trial. Diabetes Technol Ther.2011;13 (10): 997–1004.
MillerDBerardLChengAHannaAHagertyDKnipAMcDougallPWooV. Self-monitoring of blood glucose in people with type 2 diabetes: Canadian Diabetes Association briefing document for healthcare providers. Canadian J Diabetes.2011: 317–9. http://www.diabetes.ca/documents/for-professionals/CJD-Sept_2011-SMBG.pdf.
22.
WilliamsJRHumphreysEM. Some observations on the clinical significance of blood sugar in nephritis and other diseases. Arch Int Med.1919;23 (5): 537–45.
23.
LawrenceRD. Cases of diabetes mellitus with a low renal threshold. Br Med J.1929;1 (3552): 196–7.
24.
WalfordSPageMMAllisonSP. The influence of renal threshold on the interpretation of urine tests for glucose in diabetic patients. Diabetes Care.1980;3 (6): 672–4.
25.
HandelsmanYMechanickJIBlondeLGrunbergerGBloomgardenZTBrayGADagogo-JackSDavidsonJAEinhornDGandaOGarberAJHirschIBHortonESIsmail-BeigiFJellingerPSJonesKLJovanovičLLebovitzHLevyPMoghissiESOrzeckEAVinikAIWyneKL; AACE Task Force for Developing Diabetes Comprehensive Care Plan. American Association of Clinical Endocrinologists medical guidelines for clinical practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract.2011;17Suppl 2: 1–53
