Blood Sugar Testing Ineffective- Now I'm Mad!!

Here’s a story that made me really mad!!Uriëll L. Malanda of the VU University Medical Center in Amsterdam and colleagues reviewed about a dozen studies to look at the effectiveness of blood sugar self-monitoring, based upon improvements in HbA1C levels and upon patient “satisfaction”, “general well being” and health-related “quality of life”.  A1C estimates average blood glucose levels over a three to four month period, and lower values would represent clinical improvements in blood glucose control. The study looked at more than 3,000 subjects who do not use insulin, and was reported in The Cochrane Library.The results-- blood glucose self-monitoring showed only modest improvements in A1C at six months, which vanished at twelve months, and no effect on patient perceptions. Moreover, one study compared costs to urine testing for hyperglycemia and found blood monitoring twelve times more costly.This is absurd, and information like this will eventually threaten patient compensation for blood glucose monitoring supplies, certainly for patients not treated with insulin. But it isn’t the information I can blame, of course—that would be the old “kill the messenger” strategy. The question is-- why are patients not benefiting from this incredibly useful information? Dr. Mayer Davidson who authored one of the studies in the Malanda review was quoted in the Cochrane article saying, “patients aren’t using these numbers to do anything clinically significant.”So, who can I blame? I need to vent somewhere because it may well be that self-monitoring blood glucose does not benefit Type 2 patients, but self-monitoring CAN and SHOULD improve both clinical outcomes and patient perception.

• Physicians focus, naturally I suppose, on the “medical management” of diabetes. But often, in my experience, doctors will instruct patients to test blood sugar once or twice each day at set times, like upon waking, that have no relationship to lifestyle behaviors. Self-monitoring is most valuable in identifying patterns, positive or negative, related to food or physical activity. Identifying blood glucose patterns allows the patient to “manage” those things that have a positive or negative influence on glycemic control. On the other hand, sticking one’s finger first thing in the morning only to see virtually the same result each day would not lead patients to feel more satisfied or to actively modify things that could improve A1C over time. Observing how a couple slices of pizza sends one’s blood glucose level to 380 mg/dl, however, could eventually lead one to modify behavior. Diabetes management is an "activity", not a "circumstance".
• Insurance providers do not place sufficient priority on lifestyle support. Reimbursement for educational and motivational sessions with Registered Dietitians or Certified Diabetes Educators is often limited by both dollar amount and frequency allowed. While the tide is slowly changing, insurance providers sometimes seem more willing to reimburse kidney dialysis than wellness sessions.
• Patients do not take diabetes seriously, or, more correctly, do not take their responsibility for self-management by daily lifestyle choices seriously. I could deflect the “blame” onto those who should be informing and guiding the patient or reimbursing instruction, I suppose, but no matter how I can slice it too many people with diabetes simply don't commit to the lifestyle issues. And in the same way that a focus on diet and physical activity represent dedication to self care, so too does thoughtful blood glucose monitoring. It has to do with being actively engaged with one’s responsibility to manage hyperglycemia, and just as too many ignore diet and exercise so too does blood glucose monitoring become a useless task.

So what makes me so mad? That the message still isn’t getting to, or sticking with, people with diabetes—YOU can have a remarkable impact on the ultimate effect of this condition upon YOUR health. Purposeful blood glucose monitoring allows one to take action, and provides instant feedback about our own behavior. It is an incredible tool for cause and effect identification and intervention.Those who see diabetes self-management as a "spectator sport", no matter who's really to blame, do a disservice to their own long term health and to the rest of us too. Eventually, those of us who do take self-management seriously will be “out of pocket” for testing supplies and equipment, and that is one giant step backwards.Here’s a story that made me really mad!!Uriëll L. Malanda of the VU University Medical Center in Amsterdam and colleagues reviewed about a dozen studies to look at the effectiveness of blood sugar self-monitoring, based upon improvements in HbA1C levels and upon patient “satisfaction”, “general well being” and health-related “quality of life”.  A1C estimates average blood glucose levels over a three to four month period, and lower values would represent clinical improvements in blood glucose control. The study looked at more than 3,000 subjects who did not use insulin, and was reported in The Cochrane Library.The results-- blood glucose self-monitoring showed only modest improvements in A1C at six months, which vanished at twelve months, and no effect on patient perceptions. Moreover, one study compared costs to urine testing for hyperglycemia and found blood monitoring twelve times more costly.This is absurd, and information like this will eventually threaten patient compensation for blood glucose monitoring supplies, certainly for patients not treated with insulin. But it isn’t the information I can blame, of course—that would be the old “kill the messenger” strategy. The question is-- why are patients not benefiting from this incredibly useful information? Dr. Mayer Davidson who authored one of the studies in the Malanda review was quoted in the Cochrane article saying, “patients aren’t using these numbers to do anything clinically significant.”So, who can I blame? I need to vent somewhere because it may well be that self-monitoring blood glucose does not benefit Type 2 patients, but self-monitoring CAN and SHOULD improve both clinical outcomes and patient perception.

• Physicians focus, naturally I suppose, on the “medical management” of diabetes. But often, in my experience, doctors will instruct patients to test blood sugar once or twice each day at set times, like upon waking, that have no relationship to lifestyle behaviors. Self-monitoring is most valuable in identifying patterns, positive or negative, related to food or physical activity. Identifying blood glucose patterns allows the patient to “manage” those things that have a positive or negative influence on glycemic control. On the other hand, sticking one’s finger first thing in the morning only to see virtually the same result each day would not lead patients to feel more satisfied or to actively modify things that could improve A1C over time. Observing how a couple slices of pizza sends one’s blood glucose level to 380 mg/dl, however, could eventually lead one to modify behavior. Diabetes management is an "activity", not a "circumstance".
• Insurance providers do not place sufficient priority on lifestyle support. Reimbursement for educational and motivational sessions with Registered Dietitians or Certified Diabetes Educators is often limited by both dollar amount and frequency allowed. While the tide is slowly changing, insurance providers sometimes seem more willing to reimburse kidney dialysis than wellness sessions.
• Patients do not take diabetes seriously, or, more correctly, do not take their responsibility for self-management by daily lifestyle choices seriously. I could deflect the “blame” onto those who should be informing and guiding the patient or reimbursing instruction, I suppose, but no matter how I can slice it too many people with diabetes simply don't commit to the lifestyle issues. And in the same way that a focus on diet and physical activity represent dedication to self care, so too does thoughtful blood glucose monitoring. It has to do with being actively engaged with one’s responsibility to manage hyperglycemia, and just as too many ignore diet and exercise so too does blood glucose monitoring become a useless task.

So what makes me so mad? That the message still isn’t getting to, or sticking with, people with diabetes—YOU can have a remarkable impact on the ultimate effect of this condition upon YOUR health. Purposeful blood glucose monitoring allows one to take action, and provides instant feedback about our own behavior. It is an incredible tool for cause and effect identification and intervention.Those who see diabetes self-management as a "spectator sport", no matter who's really to blame, do a disservice to their own long term health and to the rest of us too. Eventually, those of us who do take self-management seriously will be “out of pocket” for testing supplies and equipment, and that is one giant step backwards.