Self-Monitoring Blood Sugar Improves Control in Those with Type 2 Diabetes Not On Insulin

With commentary by lead study author Dana Brackney, PhD, RN, CDE, an assistant professor of nursing at Appalachian State University, Boone, NC

People with type 2 diabetes who aren't on insulin can benefit from monitoring their own blood sugar, just as those on insulin can, according to new research.

blood glucose monitoring"Most people think of it as a way to adjust medications," says Dana Brackney, PhD, RN, CDE, an assistant professor of nursing at Appalachian State University, Boone, N.C., who led the study.  Those on insulin monitor blood sugar as a way to decide if they need more or less insulin, she says. However, she found those not on insulin can benefit from self-monitoring, too. Brackney presented her research yesterday  at the annual meeting of the American Association of Diabetes Educators in New Orleans.

In her small study, including 11 men and women, monitoring blood sugar produced a drop in their A1C levels over time, from 7.3 percent to 6.2 percent. Those with diabetes should aim for under 7 percent, experts say. About 1 in 10 Americans, or 29 million, have diabetes, and most have type 2.

While experts do agree that checking blood sugar helps improve control in those with type 2 diabetes who are on insulin, what is not clear, according to Brackney, is whether those not on insulin will also achieve better blood sugar control by checking their own levels.

She found it does. "Monitoring had an impact for type 2 diabetes even when they are not adjusting medications," she says. In her study, checking the blood sugar resulted not only in better blood sugar levels over time but in the participants changing behaviors in positive ways, she found.

''Patients said, 'When I see my reading [and it's high], it gets me walking a little more,'" Brackney says. Others told her that monitoring ''means I can control my diabetes, it doesn’t control me."

All 11 men and women had been diagnosed in the past two years. Diabetes educators worked with each to design personalized schedules for monitoring that would be most helpful to them. Most checked twice a day. The strips used to self-monitor glucose after getting a blood sample from the finger are not expensive, about 50 cents to $1 each, Brackney says, depending on the provider. However, she says, some health plans only reimburse for one strip a day.

The follow up period was at least six months and some participants were followed up to two years. The average age of the men and women was 62, but ranged from 47 to 73.

While many doctors don't push glucose monitoring in those who have type 2 diabetes but are not on insulin, the study findings suggest they should, says Jennifer Hsieh, DO, CDE, director of the adult diabetes program at Long Beach Memorial Medical Center, Long Beach, CA. She reviewed the study findings. Self-monitoring ''gives patients information they normally would not know if they didn't test," she says. When a patient sees blood sugar rising too much, they can act on it. "They can say, 'Oh, I had too many potatoes,''' she says, and cut back. Or they can get more exercise, as some told Brackney they did.

Testing by those who aren't on insulin is ''a positive thing," says Pamela Francis, CEE, RN, an educator in the Hampshire County Diabetes Coalition,  Romney, West Virginia. She recommends it. The drop in A1C from 7.3 to 6.2, she says, is ''a wonderful result."

Monitoring helps people know where they stand, she says. "If you are driving a car, you want to look at your speedometer," Francis says.  "Monitoring is the same thing."

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