Glucose self-monitoring: Think twice for type 2 patients
For patients with newly diagnosed type 2 diabetes, self-monitoring may do more harm than good
Self-monitoring linked to depression
Measures of depression and anxiety were scored on a 100-point scale and compared to baseline measurements. At 12 months, participants in the self-monitoring group were more depressed, scoring 6% higher, on average, on the depression subscale of the well-being questionnaire (P=.01) than those in the control group. There was a trend toward increased anxiety in the self-monitoring group, but no significant differences in well-being, energy, or any of the other diabetes attitude subscales.
WHAT’S NEW: Less may be better
Because we emphasize self-management skills when we counsel patients about diabetes, it is surprising to learn that knowledge about glycemic control and blood sugar levels does not lead to better glycemic control. This RCT provides strong evidence that more information is not necessarily desirable, at least for patients with newly diagnosed type 2 diabetes who do not need insulin.
Depression is a known complication of diabetes. It affects an estimated 10% to 30% of patients with diabetes, who have double the odds of depression compared to people without diabetes.11,12 Patients with depression and diabetes have poorer glycemic control,13,14 an increased risk of complications,15-17 a decreased quality of life,18 an increased disability burden,19,20 and increased health care use and costs.18,21,22 In addition, they face a significantly higher risk of death from all causes, beyond the risks associated with depression or diabetes alone.23
CAVEATS: Patients on sulfonylureas may be an exception
This study used metformin as the initial oral medication, with sulfonylureas reserved for those who did not reach target glycemic control with maximum metformin therapy. The number of patients taking sulfonylureas was 11 in the self-monitoring group and 6 in the control group. Because hypoglycemia is a concern in patients taking sulfonylureas, there may be a role for self-monitoring of blood glucose in these patients.
Also of note: This study does not provide definitive evidence that self-monitoring of blood glucose causes harm. Although self-monitoring was associated with a 6% higher score on a depression subscale and a trend toward increased anxiety, overall satisfaction with treatment was similar in both groups. Additional studies are needed to better understand the relationship between self-monitoring and depression.
Self-monitoring may still be a good idea for certain patients, regardless of their diabetic medication regimen. When evaluating the potential benefits of self-monitoring of blood glucose, physicians should consider the individual’s predisposition to depression, among other concerns.
CHALLENGES TO IMPLEMENTATION: Hard to forego a practice that everyone expects
Self-monitoring serves different purposes for different populations. Blood glucose levels, along with HbA1c, can guide clinicians in making treatment decisions. Knowing blood sugar levels may be educational or empowering to patients, and provides critical information if hypoglycemia is a concern. These considerations lead us to conclude that while self-monitoring is not indicated for all newly diagnosed diabetic patients, it should be considered in selected circumstances.
Because of the prevalence of self-monitoring of blood glucose, patients may see it as a key component of an optimal self-management regimen. It may be hard to convince patients with newly diagnosed diabetes otherwise—and to convince some clinicians that there is little benefit in recommending it. Again, clinical judgment is required. We suspect, however, that with the proper explanation, many patients will be relieved to learn that they will not have to prick their fingers regularly or record their blood glucose.
Acknowledgements
The PURLs Surveillance System is supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
This study was selected and evaluated using FPIN’s Priority Updates from the Research Literature (PURL) Surveillance System methodology. The criteria and findings leading to the selection of this study as a PURL can be accessed at www.jfponline.com/purls.
