Posted Jul 26 , 2019 01:40 AM
Physicians’ Views of Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes Not on Insulin.
Havele SA, et al. Annals of Family Medicine 2018;16:349-352
Institute Summary (excerpted from the abstract):
This qualitative study examines to what extent and why physicians still prescribe self-monitoring of blood glucose (SMBG) in patients with non–insulin-treated type 2 diabetes (NITT2D) when the evidence shows it increases cost without improving hemoglobin A1c (HbA1c), general well being, or health-related quality of life. Semi-structured phone interviews with 17 primary care physicians indicated that the majority continue to recommend routine self-monitoring of blood glucose due to a compelling belief in its ability to promote the lifestyle changes needed for glycemic control. Targeting physician beliefs about the effectiveness of self-monitoring of blood glucose, and designing robust interventions accordingly, may help reduce this practice.
Why is this important?
The Society of General Internal Medicine advises against daily glucose testing, yet the American Diabetes Association recommends it as does the American Association of Clinical Endocrinologists in their most recent guidelines for treatment of type 2 diabetes! Proponents of daily glucose monitoring argue that it improves glycemic control, distress, and self-efficacy when used in a targeted manner. Overall, proponents in this survey believed SMBG plays a significant role in education and lifestyle change, resulting in better glycemic control. Opponents were concerned about lack of efficacy in lowering hemoglobin A1c (HbA1c), and about the increased cost of care when SMBG is used. Proponents reported tailored negotiations about daily choices based on SMBG readings. In this small study, the majority of physicians still recommend routine SMBG because they believe it drives the lifestyle changes needed for improved glycemic control. Given that educational outreach alone has small benefits in changing behavior, targeting physicians’ beliefs about the effectiveness of SMBG, along with policy-based interventions, could reduce this practice. There is clear evidence from reviews and meta-analyses that SMBG does improve glucose control in non-intensively treated individuals with type 2 diabetes (Machry RV, et al. Diab Res Clin Pract. 2018;142:173-187). Further, there is evidence that structured testing is more effective than non-structured testing (Polonsky WH, et al. Diab Care 2011;34:262-267) and a recent study (Xu Y, et al. Int J Clin Pract 2019;April 29-e13357) suggests that testing frequencies between 8 and 14 times per week are more effective than 1-7 times per week [it is likely that those testing 8-14 times per week are more likely to be testing pre- and post-prandially which is the foundation of structured testing].This study suggests that Family Practice physicians should be targeted with better information about the value of SMBG in non-insulin using or non-intensively managed patients with type 2 diabetes! Do you use a structured approach to SMBG? Do you find patients who use that approach better understand the role of food in glucose control?
Concluding Thought: Understanding beliefs helps target education!
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