Response to Comment on: Polonsky et al. Structured Self-Monitoring of Blood Glucose Significantly Reduces A1C Levels in Poorly Controlled, Noninsulin-Treated Type 2 Diabetes: Results From the Structured Testing Program Study. Diabetes Care 2011;34:262–267

We thank Stephens et al. (1) for their comments in response to the Structured Testing Program (STeP) study. It is evident that we share an interest in ensuring that health care resources are used effectively, and we therefore welcome the opportunity to address the issues you have raised.

As noted in the letter, a number of studies in noninsulin-treated diabetes have shown data similar to those of Stephens et al.—suggesting that self-monitoring of blood glucose (SMBG), as it is typically done, offers little or no glycemic benefit (2,3). We do not disagree. Our study premise, however, is that SMBG is merely a tool, and its usefulness is dependent on how it is used. In standard usage, we recognize that noninsulin-using patients and/or their health care providers often do not make use of SMBG data; indeed, they may not know how to do so. If patients do not test frequently enough and in a structured manner to generate “actionable” patterns of SMBG, and if such data are not used to guide treatment changes, we should not be surprised to see that SMBG use is unrelated to glycemic status (or glycemic improvement).

As we reported, SMBG is of value in managing type 2 diabetes when the testing regimen is structured, the results are presented in a manner that yields easily discernable blood glucose patterns, and, perhaps most importantly, both patients and health care providers use the data to make appropriate therapeutic changes (4).

Although the studies referenced by Stephens et al. have received considerable attention, particularly from health care payers, it is important to recognize that several other studies, in addition to our own, have shown a benefit to SMBG use in noninsulin-treated diabetes (4–6). Similar to our study, these trials used structured SMBG as an integral component of comprehensive interventions that included systematic analysis, interpretation, and use of SMBG data by both patients and health care providers.

In sum, we believe that it is unreasonable to expect a positive relationship between SMBG and glycemic control if the blood glucose data are not used to guide therapy. Thus, studies that simply look at the frequency of test strip utilization do not really assess the value of appropriate SMBG use.

• © 2011 by the American Diabetes Association.