Physician-patient discussions may decrease unnecessary self-monitoring of blood glucose levels

In a cross-sectional survey at an Ohio health system, 67% of respondents with non-insulin-controlled type 2 diabetes said they monitored their blood glucose levels because their physician had asked them to, and 50% said they would stop if given permission.

Discussions with physicians may decrease self-monitoring of blood glucose levels in patients with type 2 diabetes who are not taking insulin, a recent study found.

Researchers performed a cross-sectional in-person and electronic survey between 2018 and 2020 to determine why patients with type 2 diabetes not controlled by insulin self-monitored blood glucose levels and whether they would stop if their physicians suggested they should. The survey asked about frequency of self-monitoring and reasons for doing so, as well as the impact of self-monitoring on worry and quality of life. The survey also included the question, “If your doctor said you could stop checking your blood sugar, would you?” The study results were published Aug. 13 by the Journal of General Internal Medicine.

A total of 458 patients responded to the survey, with adjusted response rates of 65% in person and 25% online. Most respondents were White (62%), female (56%), and did not have a college degree; 48% were age 65 years or older. Sixty-seven percent said they self-monitored because their physician wanted them to, 65% said they wanted to see the values themselves, and 61% said they wanted to see if their medications were working. Forty-eight percent said self-monitoring decreased their worry about their condition, and 61% said it increased their quality of life. Half said that they would stop self-monitoring if they were given permission to do so. In a regression model, those who responded that they checked their blood glucose levels because they had been told to were more likely to want to stop (adjusted odds ratio, 1.69; 95% CI, 1.11 to 2.58), while those who self-monitored out of habit and to better understand their condition were less likely to want to stop (adjusted odds ratios, 0.33 [95% CI, 0.18 to 0.62] and 0.60 [95% CI, 0.39 to 0.93], respectively).

Among other limitations, the response rate for the electronic survey was relatively low and the data were from a single health system, the researchers said. They noted that self-monitoring of blood glucose levels is most helpful in the first year after a diagnosis of diabetes, when patients are learning to manage their disease, and that most of the patients in their study had had diabetes for more than a year. “It appears that many patients practice SMBG [self-monitoring blood glucose] out of habit, not because they find it beneficial but because their doctor continues to prescribe it and has not suggested they should stop,” they wrote. “If primary care physicians are interested in avoiding low value services, it would make sense to skip SMBG altogether, or at the very least limit the duration of SMBG and revisit the need for SMBG among their current users.”