Point: Self-Monitoring of Blood Glucose in Type 2 Diabetic Patients not Receiving Insulin
The sanguine approach
- Eli Ipp, MD, MBBCH,
- Roxanne Lucas Aquino, MD and
- Peter Christenson, PHD
- From Harbor-UCLA Medical Center and Los Angeles Biomedical Research Center, Torrance, California
- Address correspondence and reprint requests to Eli Ipp, MD, General Clinical Research Center, Harbor-UCLA Medical Center, Box 16, 1000 West Carson St., Torrance, CA 90509. E-mail: ipp{at}labiomed.org
Self-monitoring of blood glucose (SMBG), one of the important technical advances in the management of diabetes in the last few decades (1,2), has provided patients and providers remarkable insights into day-to-day excursions in blood glucose concentrations obtained in natural settings. The best evidence for its acceptance by both patients and providers is the multi–billion dollar industry that has arisen to provide devices and strips that are continually improving in both sophistication and simplicity of use. Despite a documented increase in use of SMBG (3) in response to expert opinion and exhortations of the American Diabetes Association (4), no appreciable corresponding cost reduction in supplies has occurred, leading to an expanding economic burden on health care systems worldwide. Therefore, it is not surprising that the need for routine SMBG in diabetes management is increasingly being questioned (5–8).
Although SMBG as a tool for achieving glycemic targets is considered to be effective in type 1 diabetes (9,10) and type 2 patients on insulin (11,12), questions have been raised about the need for its use (5–8) in the majority of potential users, non–insulin-treated type 2 diabetic (NIT-DM) patients. Those challenging the use of SMBG in NIT-DM patients generally cite two major problems in support of their position: the enormous cost of supplies and the lack of evidence for effectiveness in this group. In many well-run health care systems, this combination is usually sufficient to put an end to a medical practice. In this commentary we will address these two claims and point out why providing SMBG in NIT-DM patients is still necessary.
The cost of SMBG is unarguably a major expense in health care delivery (8). In the U.S. alone, SMBG leads to an annual expense of hundreds of millions of dollars …
