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Finger-prick testing ‘not necessary’ for many patients with type 2 diabetes

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Self-monitoring of blood glucose levels by patients with type 2 diabetes who are not on insulin does not improve glycemic control or quality of life, according to a US trial.

The results show that using blood testing strips may not help diabetes patients who do not use insulin and suggest self-monitoring should not be routine in this group, said the study authors.

“Our study results have the potential to transform current clinical practice”

Katrina Donahue

They describe their findings, published in the journal JAMA Internal Medicine and presented at the American Diabetes Association 77th Scientific Sessions in San Diego, as “landmark”.

They noted that the majority of type 2 diabetes patients were not treated with insulin but were often recommended glucose monitoring.

This was despite an ongoing debate about its effectiveness in controlling diabetes or improving how patients feel, said the researchers from University of North Carolina at Chapel Hill.

Proponents of blood glucose testing have argued that daily testing promotes better awareness of glucose levels, leading to improvements in diet and lifestyle.

A number of smaller trials have previously shown mixed results in attempting to verify this. Several suggested a benefit for testing, while others found none or that testing could even be harmful.

Meanwhile, there have previously been warnings in the UK that patients with type 2 diabetes were at risk because the number of blood test strips available on the NHS were being rationed to cut costs.

Test strips cost the NHS an average of £14 for a pack of 50, but some trusts obtain a much lower price from manufacturers.

The latest trial involved 15 primary care practices with 450 patients with non-insulin-treated type 2 diabetes. Patients had an average age of 61 and had had diabetes for an average of eight years.

Patients were assigned to either no blood glucose monitoring, once daily monitoring, or enhanced once-daily monitoring with an internet-delivered tailored message of encouragement or instruction.

By the end of the one-year MONITOR Trial, there were no significant differences in blood glucose control across the three groups.

University of North Carolina at Chapel Hill

Finger-prick tests ‘unnecessary’ for many type 2 diabetes patients

Katrina Donahue

In addition, there were no difference in the number of individuals who had to start using insulin treatment and no significant differences found in health-related quality of life.

There were also no notable differences in hypoglycemia, hospital admission, and accident and emergency visits.

Senior study author Dr Katrina Donahue said: “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?’.

“Of course, patients and providers have to consider each unique situation as they determine whether home blood glucose monitoring is appropriate,” she said. “But the study’s null results suggest that self-monitoring of blood glucose in non-insulin treated type 2 diabetes has limited utility.”

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