HFHT's Practising Wisely Newsletter
For clinicians, by clinicians.
Issue 21: The Real Deal on Self-Monitoring Blood Sugars 
April 25, 2017

In a previous newsletter, we talked about screening for diabetes. Despite following the recommendations to avoid doing blood sugars on asymptomatic and low risk patients, we inevitably still find new diabetics. Once these patients are stabilized, what are the recommendations for routine self-monitoring of blood sugars?

According to ICES, the total cost of test strips for older Ontarians will exceed $500 million dollars between 2009 and 2013 (check out the Quick Links section for more information on this article and other information and recommendations referred to below).

So we should avoid telling some of our patients to test when recommendations like the ones below say it's not necessary!

What the Recommendations Say

Recommendations about self-monitoring blood sugars come from the list of Choosing Wisely recommendations from Family Medicine and Endocrinology and Metabolism:

  1. "Don’t advise non-insulin requiring diabetics to routinely self-monitor blood sugars between office visits. While self-monitoring of blood glucose (SMBG) for patients with diabetes is recommended by certain groups to help monitor glycemic control, for most adults with type II diabetes who are not using insulin, many studies have shown that routine SMBG does little to control blood sugar over time."

  2. "Don’t recommend routine or multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia. Once target control is achieved and the results of self-monitoring become quite predictable, there is little gained in most individuals from repeatedly confirming this state. There are many exceptions, such as acute illness, when new medications are added, when weight fluctuates significantly, when A1c targets drift off course and in individuals who need monitoring to maintain targets. Self-monitoring is beneficial as long as one is learning and adjusting therapy based on the result of the monitoring."

Also: A 2010 review published in the CMAJ found frequent self-monitoring (≥ 7 times per week) is unlikely to represent efficient use of finite health care resources, although periodic testing (e.g., 1 or 2 times per week) may be cost-effective, and an article by the Therapeutics Initiative echoes the same sentiment.

Save yourself some time in the office, and save the health care system (and your patients) some money by rethinking whether or not self-monitoring is appropriate! 

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