Fingerstick Testing May Not Benefit All Patients with Type 2 Diabetes

The results from a large pragmatic trial published by JAMA Internal Medicine suggest that checking blood glucose levels through fingerstick testing may not be beneficial for patients with type 2 diabetes who are not treated with insulin.

Approximately 1 in 11 Americans have type 2 diabetes. For patients receiving insulin therapy, fingerstick testing to determine blood glucose levels is the accepted practice. While a majority of patients with the condition are not treated with insulin, they are typically recommended to monitor their glucose levels.

"Our study results have the potential to transform current clinical practice for patients and their providers by placing a spotlight on the perennial question, 'to test or not to test?'" said senior study author Katrina Donahue, MD, MPH.

Included in The MONITOR Trial were 450 patients who were assigned to a group: no blood glucose monitoring, once-daily monitoring, or enhanced monitoring with an internet-delivered message to encourage or instruct patients.

At the end of 1 year, the authors found no differences in blood glucose control among the 3 cohorts. They also discovered no differences in health-related quality of life, indicating that fingerstick testing may not improve health among these patients, according to the study.

The authors also noted there were no significant differences in hypoglycemia, hospitalizations, and emergency department visits. There were no differences in prevalence of patients who had to begin treatment with insulin to better control their blood glucose levels among the cohorts.

"Of course, patients and providers have to consider each unique situation as they determine whether home blood glucose monitoring is appropriate," Dr Donahue said. "But the study's null results suggest that self-monitoring of blood glucose in non-insulin treated type 2 diabetes has limited utility. For the majority, the costs may outweigh the benefits."

A majority of Americans with type 2 diabetes control their insulin with exercise, diet, and medications, such as metformin. While a large portion of diabetes patients do not receive insulin, more than 75% perform fingerstick testing.

Advocates for blood glucose testing suggest that it increases awareness of glucose levels, which may lead to improved diet and lifestyle.

However, previous clinical trials have shown positive results proving the benefits of testing, while others have shown that the tests can be harmful. Daily tests can impose a significant financial cost and can increase depression or anxiety among some patients, according to the study.

"There was no difference between either type of testing," said first author Laura Young, MD. "Enhanced Self-Monitoring Blood Glucose, in the pragmatic setting of regular daily life, offered no additional health benefits."

The authors suggest that patients with diabetes should discuss the need for fingerstick testing. If it is determined that the tests are unnecessary, it can save patients hundreds of dollars annually, according to the study.

"There has been a lack of consensus, not just in the United States, but worldwide," Dr Young concluded. "The lack of standard guidelines makes it all the more difficult for patients, who are already struggling to manage a chronic condition. And at the end of the day, patients have to make a choice."