Does home monitoring of blood glucose levels improve glycemic control or quality of life in patients with type 2 diabetes who are not using insulin?

Lots of numbers, lots of money, lots of strips in landfills, little to show for it. Home glucose monitoring of patients in primary care does not improve hemoglobin A1c scores or quality of life over 1 year in patients who are not taking insulin. Patients did not feel more empowered or satisfied as a result of home monitoring nor have fewer hypoglycemic episodes, and their physicians did not seem to respond to the home glucose levels to any beneficial effect. (LOE = 1b)

Young LA, Buse JB, Weaver MA, et al, for the Monitor Trial Group. Glucose self-monitoring in non-insulin-treated patients with type 2 diabetes in primary care settings. A randomized trial. JAMA Intern Med 2017;177(7):920-929.  [PMID:28600913]

Randomized controlled trial (nonblinded)

Government

Concealed

Outpatient (any)

These researchers identified adults (average age: 61 years) with type 2 diabetes not treated with insulin and hemoglobin A1c levels between 6.5% and 9.5%. Most of the patients (75%) monitored their blood glucose levels at home prior to the study but had not been seen by an endocrinologist. The 450 patients (who had type 2 diabetes for an average 8 years) were randomly assigned, using concealed allocation, to 1 of 3 arms: (1) no home glucose monitoring; (2) standard once-daily monitoring; and (3) enhanced once-daily monitoring, consisting of glucose values immediately reported to the patient plus automated, tailored messaging delivered via the meter. The patients' physicians were given the home glucose monitoring results but were not asked to follow a specific protocol to respond to them. After both 6 months and 1 year, there was no difference, on average, among the groups in hemoglobin A1c levels, hospitalizations, episodes of severe hypoglycemia, or quality of life scores. Similarly, there was no difference among groups in treatment satisfaction or feelings of empowerment.