The one thing the new recommendations overlook is that diabetics' blood sugar control can change over time. If they're not testing, they won't know until they see a doctor for some reason.
A good friend was managing his blood sugar well with diet and exercise, and his at-home tests showed that. When he ran out of test strips, he didn't bother to get more, but he continued his very good lifestyle.
Two years later, he had a medical emergency unrelated to his diabetes, but they tested his A1C and found he was no longer keeping his blood sugar in a healthy range. But for that emergency, he could have gone quite a while damaging his eyes, kidneys, etc., without knowing it.
This article basically states that you don't need to test, just take your meds. I was diagnosed with Type 2 diabetes 10 years ago. And I've never taken any meds because my A1c is fine. How did I manage that? I tested and tested and tested some more. I ate LCHF. And I exercised. Not perfectly, because no one is perfect. But well enough to keep my blood sugars low enough not to need medications.
So, it's an n=1 anecdote. But I know lots of people with Type 2 diabetes who no longer take medications because they did the same thing-tested to see which foods were spiking their glucose levels and sticking with some version of a low carb diet and an exercise program. Or, for some, a vegetarian diet or Mediterranean diet or whatever diet does the job.
The thing is that medications aren't a magic pill that makes you better. They don't stop the progress of the disease. They just control the symptoms. So you have to keep adding more meds as the disease gets worse and the medications you're taking no longer do the job.
But the right diet for you and the right exercise program does stop the progress of the disease. It heals insulin resistance, as long as you continue to follow it. But if you don't test, you can't figure out what the right diet and exercise plan for you is.
Personally, I'd rather test, eat the right diet for me, exercise, and keep diabetes in remission than not test and take medis, and more meds, and more meds as the disease continues to get worse.
1
@Linda
As a health coach, you are spot on. The article suggests that not testing and just keep merrily going along on the SAD, (standard American diet) and taking meds and not to worry is the worst advice anyone could give. Testing is critical for anyone who wants to take control of their diet and lifestyle. Those who are motivated to test will be motived NOT to become diabetic. The article is a real disservice to the one in three Americans who are either pre-diabetes or type2 diabetes and most don't know it.
In an article today in the NYT about lowering the age that is recommended to be tested for blood levels of glucose. If people were more aware of the complications of getting diabetes they would want their blood tested!
I think this article and the study it is based on send the wrong message. There should have been a group that were given Continuous Glucose Monitors (CGM) instead of test strips along with the education to understand and react to what the monitor is telling them. If the study had provided the result for a pool of CGM users than I think the argument to discontinue home testing using finger pricks and test strips could be bolstered. Just not towards less testing but toward more testing through the usage of a CGM. The prices are prohibitive for most. I am lucky enough to be able to afford a 14-day sensor patch prescription (~$79/month) that works with my smartphone. Glucose management takes on a whole new dimension when every food choice is writ large on your phones screen and shared with a caregiver. I dropped A1C from 10.1 to 6 .2 in a period of 90 days. I was also able to determine which foods trigger the greatest changes in my blood glucose and I was able to validate that pairing healthy fats with carbohydrates reduced the impact of low glycemic carbohydrates. The Government's dietary guidelines from the 70's (remove fat, add carbs) is the progenitor of this epidemic. Going back to healthy fats and reducing fructose in all processed foods is the only way to reverse the course of this disease of diet.
4
I'm pre diabetic and a medical professional. When I first saw that I was pre diabetic, I went out and got a meter.
As others have mentioned, just getting a "number" doesn't do much unless you educate yourself about what that number, at that time of day means.
Example..I found that my morning fasting glucose was often higher than my glucose before going to bed the night before, although I ate nothing overnight. The "morning phenomenon" or the "Somogyi" effect is the cause. You have to know that. So morning testing is useless to me.
However, testing 2 hours after eating, or eating and exercise tells a lot. You can adjust your diets. Learn to exercise more. Lose weight and just watch the effect that has on your glucose numbers.
And, if you don't test periodically how will you know if things are getting out of whack in spite of what you are doing? Wait for full blown clinical symptoms? Why? When you may be able to prevent them by taking appropriate steps before you become clinical.
Nosirree! I see no downside to testing (except the expense) as long as you educate yourself as to what the results mean.
8
@SAH Thank you for putting a name to what my husband goes through, when he checks his levels in the AM. I googled Somogyi, and forwarded the Wiki page to him.
Have a good day!
What pure unadulterated nonsense. Of course testing is important. People should have a good idea what their blood sugars are to help them maintain a good regimen of diet and exercise.
Or as Shakespeare says, "If ignorance is bliss, then, 'tis folly to be wise."
2
When I realized that my glucose was almost the same every day and my A1c was ok, I cut down testing to weekly unless I was ill or I suspected my eating habits weren't good. I would guess that some people with bad glucose or bad habits should test more often as a reminder.
1
Having Type 2 diabetes for almost 20 years I read the article with great interest and came away sadly disappointed.
The research and the article could lead diabetics to conclude they don’t need to test. Worse, I’m sure insurers are already looking to use the research to stop paying for testing. While the research would suggest that’s fine because the outcomes won’t change it ignores the fact the outcomes aren’t acceptable and that we can do much better.
Speaking from experience, daily testing fails to change behavior because the data isn’t immediately actionable. The feedback is too far removed from the cause. I myself have lapsed into periods of not testing over the years; always with predictable results.
Recently I found my solution; continuous glucose monitoring. A small device tests my glucose every few minutes and reports it to my phone 24/7. I get feedback while I’m eating that changes my behavior. I learn exactly what I’m doing that affects my blood sugar. With the new device my average blood sugar dropped from almost 300 to 135 in two weeks. That’s equivalent to an A1C of 6!
The message should be that testing is vital for diabetics. If the outcomes aren’t supporting that it’s because the testing isn’t sufficient to change behavior.
11
Knowledge is power. I have type 2 diabetes and test with a glucose monitoring patch. Understanding my glucose readings and the effect of activity and diet is critical to diabetes control. Of course my insurance company would not pay for the monitoring system. I am fortunate that I can pay for the device out of my own pocket.
1
Strongly disagree with controversial recommendations presented by this article.
Upon diagnosis of T2D in 2015, where I had failing health, massive fungal infection, glucose tests at 260, and a1c of 8.3 - I began program monitored by my endocrinologist to heal myself. Everyday, I ate food based on guidance from a diabetes well training class, exercised, and validated my choices through the objectivity of a weight scale, urine color, and ... test strips.
One test in the morning for fasting, one at night 2 hours after dinner.
One year later, I was running almost 20 miles a week and had lowered my body weight from 240lb to 170lbs, my waist shrank from a 44 to a 34, and my endocrinologist measured my a1c at 5.6
Metformin was removed from my daily.
Kept running and continued daily experiments on food, validated with test strips and maintaining a1c.
Tried my first marathon and diabetic crash at mile 18. Learning continued (via test strips) on how to stay fueled.
Just a couple of months ago, a1c measured at 5.4, and 3 weeks ago, I ran my first full marathon.
I know that I am an outlier in thre personal struggle against T2D, but I could never have achieved my goals without the objectivity of the test strips.
They allow me to eat and know my body’s limits.
Sometimes, I test more frequent so I can compare how I’m feeling vs instantaneous glucose level - results have sometimes been extremely surprising.
Testing less than twice a day is a waste. Not testing is death.
9
I respectfully disagree with the article. I am technically competent and motivated. The little glucose checks are a valuable tool for monitoring what I realize is my health and longevity. My big problems are everything tastes so good, and planting my butt in front of a screen is so comfortable.
4
Having lived with a Type 2 diabetic sister for many years, I believe home testing can be effective, but only when the diabetic person is striving to maintain control. From what I've observed, the biggest roadblock to that is a deplorable lack of knowledge across the entire spectrum of the medical profession, even among some endocrinologists. My sister has been fortunate to have finally found a physician who sees her as a whole person and treats her as such, tries to help without heaping blame when things arem't going as well as hoped, and welcomes her active participation in her treatment. He does his research and she does hers; she listens to him and, more importantly, he listens to her and, between them, they usually produce a positive result. However, until she found this doctor, her disease was not under control and she often felt there was hardly any use even trying, as the only thing she got from her doctors was finger-pointing, an "it's your own fault" attitude and very little useful information. Most of what she knows about her diabetes today she learned from her own efforts and having a truly knowledgeable and helpful specialist in her corner. It's not the question of testing, but to what extent diabetics are empowered to use that information in enhancing their well-being. And they cannot do that unless they and their medical family are knowledgeable enough to work together toward that goal.
10
The tests won't change outcomes but diet and exercise will. people testing and taking pills are not changing their circumstances and type 2 diabetes is a condition that is often changeable, treatable, and curable.
1
One test a day doesn't tell much about your glucose control unless it is randomized, e.g wake-up, pre-meal, 2 hrs. post meal, bed-time .
Most glucometers can connect to computers for data analysis provided by the manufacturer's software. In the least, a paper log book that records the one-test-a-day in a varied pattern e.g. pre-breakfast (wake-up), 2hrs. post breakfast, pre-lunch, 2hrs. post lunch, pre-dinner, 2 hrs. post dinner, and bedtime will probably allow a window into a pattern of blood glucose excursions and averages.
If one improves the averages found through random time data acquisition, it is nearly impossible to not improve the A1c.
3
I think that home tests even for type 1 diabetics is a waste of time and resources. In the first place, money or resources ought to be used in preventive medicine, altering food and diet habits of the mainstream. So much sedentarism has obesity as a pandemia and diabetes evermore common in kids and adolescents. As a sufferer of type 1 diabetes, medical journals and practitioners ALWAYS miss the point: WE need help in the form of companionship, psychology, psychiatry to help us better understand why we should bother or care to do the home tests, exercise, diet adequately and avoid the depression that per se seems to also accompany us, which like a hypo or hyper glycemia arrive without any warning any signal. I think that actually would make health spending wiser and much more efficient.
I think this article sends wrong signals to patients having Type - 2 diabetes. I fall under this category for the past 17 years and I have been using the test strips ever since I am having diabetes. In the beginning I used to test almost on daily basis. Slowly I reduced the frequency to once in a month or once in two months or whenever I felt my sugar level was somewhat low. In between I used to get the lab tests done to check whether the lab values are in line with the test strip results.
Diabetes is no joke. If we neglect it will impact all other body parts and even causes heart attack. One should get it periodically checked whether in a lab or at home inspite of taking regular medication since the rise and fall of sugar level also depends upon our food intake quality and quantity wise.
1
I have well controlled Type II diabetes. Once, immediately after getting a fasting blood draw glucose test, I did four tests with my home meter in rapid succession. While the average of these four tests was near the professional test, they varied by over +/- 10%. This is actually equal to or better than the fine-print predicted variance of these home machines. The readings ranged from normal to troublesome.
I understand that these tests are very helpful for people who take insulin. In my case, however, it was obvious that they provided no detailed clinical information. The error is so large that they are not, for instance, useful for determining my sensitivities to particular foods.
I suspect that many people are mislead by the reported precision given on their meters into thinking that the data is more meaningful than it actually is. The confusion of precision and accuracy is a well known route to error in scientific fields.
Anecdotal evidence is difficult to generalize, but my experience is in line with the conclusions of this article. I have not used the meter since my four near-simultaneous tests, but rely on periodic A1c measurements.
2
It is much better for diabetics to have their walking or other physical activity measured.
There are city walkscores. There need to be personal evidence based walk scores.
From what I read about insulin prices, the picture at the head of this article are about $2700-$3000. Perhaps the gov't could set up contracts for this drug and Sodium thiopental to be manufactured on an emergency basis.
3
My personal experience contradicts the results of this study, which, with just 450 subjects, is too small for a disease that affects so many people.
I am using my morning fasting testing--just once daily--to improve my diet, in combination with a food diary I keep on LoseIt. I learned quickly that the amount of food I ate affected my numbers much more than the kind of food, unless I gorged on candy or high-carb foods shortly before bed.
I may do testing before and after workouts, too, as I start an exercise program this spring, so I can see the effects on my blood sugar level.
Daily testing is helping me stay conscious of portion control, helping me make better choices when food shopping, and is an integral part of meeting my health objectives. If it helps me keep my A1C below 6 and allows me to use just diet, exercise and metformin to control my sugars--so I don't progress to needing insulin--isn't that a net positive, in terms of my health and overall cost?
I invented my protocol on my own, but wish doctors would get on the stick and tailor weight loss and fitness programs for their diabetic patients that use blood sugar testing as well as weigh-ins to stay on track. Once they've found an approach that works for us, they can address the patients with metabolic syndrome. Maybe we'd start seeing fewer people diagnosed with this condition.
8
People need to do what they are comfortable with, but you should think about costs, and benefits. And don't be moved by marketing efforts by manufacturers and sellers of testing equipment. They are in the business of making money whether you need the devices or not.
I have been Type 2 diabetic since about 2005 and have been on Metformin daily after finding that a different drug was causing weight gain. Initially I tested myself religiously to see how I reacted to different foods and meals. Also, I wanted to get my HbA1c down from the initial 8.0 reading and to lose some weight. After these steps my HbA1c dropped to a consistent range of about 6.2 to 6.6 within a few months, which is fine, according to my doctors. Thereafter I have relied on that test twice a year rather than doing daily blood samples. I had read somewhere that close control of blood sugar for older people can cause more problems than it solves, i.e., earlier death.
About a year ago, the American College of Physicians relaxed the guidelines for HbA1c targets from a range of 6.5-7.5 to a range of 7.0 - 8.0. The article announcing this in the Annals of Internal Medicine also noted that for patients with a life expectancy of less than 10 years due to age or other health problems (cardiovascular, cancer, etc.) the goal of diabetes control is to avoid hypoglycemia rather than reaching a particular blood sugar level.
2
If I hadn’t tested my blood sugar a year ago, after a month of taking steroids, I wouldn’t have known it went super high. A conversation with my endo and some course correction fixed everything. I test very often just to make sure things are under control, and also after eating things I don’t usually do, to see the effect. Sime of these foods I know avoid, or have reduced. I will continue testing.
6
I have had Type 2 diabetes for about a decade, with—as the author of the article advocates as sufficient treatment for T2D—"regular administration of the same drugs on a set schedule." I began treatment with insulin about six months ago due to my blood glucose ranging out of control, including an episode over 750. At the same time, I started using a CGM (continuous glucose monitor) to monitor and track my glucose levels.
Had I been able to do this before my blood glucose went out of control, it might never have gone out of control. The CGM is the single most effective tool I have in my treatment arsenal. It would have been the most effective tool in my treatment arsenal if I'd had it prior to needing insulin. The knowledge it provides, if heeded and acted upon, is more powerful than any drug.
Though I was already educated on the subject, the CGM has opened my eyes to the relationship between diet, stress and glucose levels in a way that no amount of indirect information could ever impart. I had been doing "finger stick" measurements but they only provide snapshots, which is like comparing random, hit-or-miss audits with a CGM's security camera approach.
Again, and as opposed to what the article asserts: if'd had this CGM tool before it became a necessity, it probably never would have become one—and I wouldn't be on insulin today.
12
As a hospital based Master Degree Certified Diabetes Educator with 17 years experience, I have seen similar reports several times. I will simply tell readers to read the "Readers Picks" to this article to understand my stance.
Readers Picks point out the realities of proper BG testing.
I will simply state, one BG test a day means next to zero, especially if the patient simply logs their BG, without instructions about the significance of the number.
I have seen patients bring in a year long log book of readings constantly 300 to 400 mg/dL, which indicates major therapeutic problems exist on a daily basis.
Without dietary instructions or medicinal changes to lower their BG's below 140 mg/dL, simply recording such excursions has no value.
However, correct usage of a glucometer, Type 1 and 2, can significantly lower A1c readings, which leads to less nephropathy, neuropathy, retinopathy, and other microvascular disorders related to uncontrolled diabetes.
Ultimately, I must guess this article is written by an author who has minimal clinical experience with diabetes, or who simply is following an oldschool cookbook recipe for patient DM treatment. Read the Readers Picks, top to bottom, for the true story.
8
Hi, Just a note for the editor: the photo for this story is humalog insulin, but the story is only about recommendations for people who don't take insulin. It's a little confusing, may want to find alternate.
4
I am pre-diabetic, and it was only through testing that I was able to eliminate foods that caused my blood glucose to rise higher than I would have ever imagined. Adjusting my diet quickly got rid of mild complications of diabetes that were already affecting my life. I can now track my diet day to day, adjusting foods and portion sizes. I am hopeful that my next HbA1c test will reflect a non-diabetic status. However, I know I will always have an impaired glucose tolerance.
4
I strongly disagree with the conclusions of this article.
While I suspect that the study is well done and that the conclusion about outcomes is statistically valid, I disagree that an educated patient cannot gain from regular self administered glucose testing and record keeping for Type 2 diabetes.
I glucose test three times a day regularly and never less than once a day on particularly busy days. What I gain from testing is a trend data by which I can highly accurately predict my A1C reading and can assess the state of my blood sugar level. Since elevated blood sugar has direct effects on my energy level and alertness it is a very valuable test. Furthermore it helps me evaluate foods and portions accurately and control my blood glucose level for optimal performance.
Now I admit that I am a scientist trained in data interpretation and and that I use myself as a human subject to fine tune my diet and exercise routine. I could not accurately and reproducably do this without an accurate glucose meter to collect accurate data.
Furthermore I correlated these data with information from genomic DNA testing which has allowed me to research my particular variety of SNP mutations that produced my particular T2D. T2D is more of a genomic syndrome than a disease it varies from individual to individual.
Yes I drive my primary care physician a bit crazy but as an informed patient I take better care of myself and feel better.
10
I have diabetes type 2 and I monitor my glucose levels to make sure they don’t spike or dip too much in either direction. I don’t “feel” my diabetes, that is to say I only know what my levels are by testing. If I don’t monitor but change my lifestyle or diet how do I know if it’s working?
7
But, but ... isn't it more important for Big Pharma to make money than to really make sure patients get the correct, affordable medication?
4
Two things I took from this article:
1. The conclusion that testing made no difference to the outcome (i.e. that testing didn't make the diabetes better) is facile, and to my mind irrelevant. No one testing their blood glucose level treats the activity as medication. We test so we know that our blood glucose is OK today. One day it might not be, but if we don't test, how do we know? There aren't any symptoms, as a rule, until you get really ill. So if that was the object of the study, then the study was a waste of time (and money).
2. Most importantly, it transpires near the end of the article that, just like in Australia, it's really only about the money. Your government, just like ours, is looking for ways to cut health spending for the less well-off, as they do. And just like our government did, they will use this fatally flawed study to do it. They ought to be ashamed of themselves.
These professionals seem to be suggesting that testing can cause anxiety. It may be that some degree of anxiety might be caused by NOT testing. I find their proposition to be ludicrous.
In fact the study seems to me to be made up in an attempt to justify the required answer to a question which need never have been asked.
Just a thought: maybe the test strips could be made less expensive. The prices charged are outrageous in Australia: around $1 per strip. I'm sure that if the price were related in any way to the cost of production then the expense would be much more manageable.
9
It seems from comments and what I already knew that testing once a day is a meaningless description. When the testing takes place is essential information, because the significance of a test is very different if before a meal or after, and how long after, and whether first thing in the morning, or whenever. It follows that, if the study didn't track when the testing was done each day, it is useless. If the author didn't know that, who the heck is he to interpret it?
2
This is stupid... daily Glucose testing in the morning after overnight fasting is cheap... I use the top level glucose strips and it cost as little as a dollar a day ($30 per month)... if sugar excess in blood is a problem it will show up in the fasting blood test, most likely, and of course everyone with insurance gets A1c test for checking long term glucose excess... physicians should not be advocating for people to stop daily blood testing... it keeps in your mind that you are a diabetic... since we sometimes forget!
6
Its about a speedometer.
I can work out my average speed by timing my journey and measuring the distance. but a speedometer provides immediate feedback especially when a cop is around.
Logic tells me the 3 month test is adequate.
But a more frequent reading is reassuring (no daily test for me because I can't stand the pricks)
1
Testing can provide actionable results. You can take positive action without testing, and you can test without taking positive action. Both scenarios would lend support to the arguments being made. The best scenario would be to have the best tools available for where the person is in this disease, what they need to learn, what they already know, how they are actively managing their disease -or not managing it. How about CGM for all at diagnosis until stable control is reached, and then as needed, after discussion between the individual patient and heath care provider? Some will never reach stable control for reasons as varied as people. But this epidemic is now too widespread for simple answers. That some patients cannot get the meds and supplies that they need to live safely, while others sell excess supplies, means that one size fits all is a crisis.
2
As a family physician I try to tailor my advice about how to follow blood sugar to the individual. But for many of the non insulin dependent diabetics on my practice I recommend checking their sugar seven times a day once or twice a month; before each meal and 90-120 minutes after the same meal and at bedtime. I also recommend checking sugar after eating any new foods not usually in their diet and also if they just don’t feel right. We then review their data at an office visit.
Glucose records full of numbers that don’t give any useful actionable information just serve to hurt your fingers!
Now if everyone could access a continuous glucose monitor and a continuous blood pressure monitor and was willing to do something beneficial with the results we might see a huge improvement in morbidity and mortality.
3
While blood glucose monitoring is an important tool for insulin treated people with diabetes, who need to adjust their insulin doses accordingly - self monitoring of blood sugar is also necessary as an educational tool for people who do not require insulin treatment. Diabetes education today is executed poorly for many individuals who are new to the disease. But at least, the ability to measure one's own blood sugar after meals, can instruct better mealtime food choices - better perhaps than formal nutrition classes.
As I read the study results from the Monitor Trial (the basis for Aaron Carroll's Upshot) there was a significant improvement in A1c outcomes at 6 months into the trial, but not at 12 months. (How do the authors explain this?) Moreover, the Monitor Trial chose only individuals who were established patients at a participating practice i.e. not the newly diagnosed cohort of patients who would be most susceptible to the educational benefit of self-glucose monitoring. To then conclude that the "best research is telling us that they don’t need to — that in fact it’s a waste of money" is deeply flawed.
I fear that government bureaucrats and health insurance industry "bean-counters" reading this article will mount a new campaign to deprive people who need and use this tool; a huge and hurtful mistake.
4
Couldn’t agree more - more information is better than less. How can you construct and tailor eating / medication approaches without feedback upon which to base it? Dr. Boxhill knows whereof he speaks. 40 years as a Type 1 under his tutelage I developed good habits and stayed healthy and this included regular testing. Testing is a burden, but integral to the landscape that comes with having this chronic illness.
Newly diagnosed T2D patients might benefit from having CGM (continuous glucose monitoring) temporarily to determine how dramatically the carbohydrates they consume impact their BG. I would venture to say that no one needs carbohydrates. I’ve consumed less than 20 g/day, with no ill effects for the past 2 years. While I will concede that CGM can often lead the patient (and practitioner) down the rabbit-hole of chasing a naturally occurring sine wave of BG, it can been a tool for learning to avoid carbohydrates, and lessen the use of insulin, overall. The work of Richard Bernstein, MD and Jake Kushner, MD is illustrative of appropriate BG management for T1D, too; the prescription for BOTH types of diabetics is the same: lower insulin response, whenever possible, by ingesting less carbohydrates.
5
@Paula M. O'Buckley
That carbohydrates are nonessential is a statement seen over and over again in comments (one very prolific commenter comes to mind) - whether the subject is diabetes, heart disease, or any of the other lifestyle diseases that afflict the modern world. The problem with that line of reasoning is that plants are mostly carbohydrates, so in essence the claim is that plants are nonessential.
Plant foods are essential to good health, and all the evidence thus far shows that long-term good health cannot be achieved without a significant quantity of plant foods in the diet. Type II diabetes is (was) rare in populations consuming such diets, almost all of which were higher in carbohydrate energy than the American diet.
Individual patients' needs vary, but for most, following a very low carbohydrate diet is neither necessary nor feasible in the long run.
1
AND VEGETABLES is precisely where those 20 or so grams of carbohydrates comes from! for nutrients, micronutrients, fiber, etc. What is being stated is not that all carbs are unnecessary (from most commenters), but that "empty" carbs are unnecessary, and are certainly the carbs most people consuming the "standard American diet" are consuming.
2
@childofsol
There are lots of essential nutrients in plant foods, just not carbohydrates. Fiber is kind of a gray area, maybe essential to the health of the gut biome. But neither glucose nor fructose are essential nutrients. Useful in some contexts, sure, but not strictly essential.
I've always favored omnivorous diets that include plant foods. You're the one who has consistently defended diets of bread, pasta, and cereal (plant foods, sure, but also highly processed carbohydrates).
Blood glucose monitoring can be very useful if the individual with T2DM uses it in a practical way. Many individuals are simply given a monitor and strips and have no understanding of context. I believe for the person with T2DM the most helpful way to use it is to check blood glucose 2 hours after their largest meal and evaluate the glucose level and the portion of carbohydrates eaten. This gives them both a sense of what they are eating and how it impacts their blood glucose, thereby increasing their awareness of impact of diet on blood glucose and gives them the ability to adjust their food. Sometimes individuals find that they are grazing a lot of they day, when they find that they can't identify a clear 2 hour time point. Often this feedback can be used to impact on activity as well. All of this information is helpful and educational. Education is key, the readings should not increase anxiety. No one needs to do this multiple times a day unless they are taking insulin, or are symptomatic or their blood glucose is out of control and they need additional monitoring. This can be a very helpful tool when used appropriately.
Additionally, would agree that the costs are also aggravated by the artificial market and greed. There is no reason the strips should cost as much as they do. There are so many costs of medicine that should be diverted to making more of a relevant, clinical impact rather than lining companies' pockets.
2
While the article points out studies on testing, I think the Author is pushing an innacurate point - that testing is a waste of money, especially the publics money. As a Type II diabetic who was origionally orally medicated and eventually put on insulin, a patient who is methodical and tests multiple times daily before they eat - and then moderates their behavior can sucessfully control their A1C. For those that cannot, it is at least an understanding of how far out of whack they are. But the real issue is twofold. 1) Testing should not cost what it does. It's an artificially inflated market. The technology is old and can be produced inexpensively - for something that 25% of the population could use, it remains outragously expensive and so - people don't test or test once a day rather than sampling enough to make control possible. Secondly, it's dangerous for studies like these to drive formularies because you are removing a tool that works for some. The testing is not the problem. Taking tools out of patients hands is not a solution. The article elluded to education, and yes, that is a part of the solution. Ultimately, the diabetic, like all animals is addicted to food. Behavior modification is hard. But averaged results cannot show the value of control on a day to day level. We need studies that include the behavior modifcation aspects to really understand the impact. Don't argue for the removal of a tool. Argue to make its cost nominal and use ubiquitous.
9
I am Type 2 Diabetic. I was diagnosed in November 2016, when during a routine check-up, my HbA1c reading was 18.7%. I was immediately put on Jardiance Duo twice per day. I later switched to xigduo XR, which I take once every morning. When I began treatment, I also started a routine of measuring my blood glucose. At first, it was several times every day. Now it is once in the morning. Also, I keep a spreadsheet of every meal and snack that I eat along with the blood sugar readings. By January 2017, my HbA1c dropped to 6.4%, and it has been in the range of 5.5% to 5.8% ever since.
I would not argue with the conclusion reached in the article. I could probably stop the daily blood glucose measurements and the detailed tracking of my diet. When I was new to Diabetes, I needed to track this data to understand the relationship between my diet, exercise (tracked using my Apple Watch), blood sugar, and HbA1c. Now, I find these habits useful; they help me to remain mindful that I have the disease and to maintain control.
7
I have observed that the glucose test kits give varied results even when you re-test within a few minutes. I experimented this multiple times, at the cost of using more than two test strips. I never got same reading and sometimes there were differences of more than 10%. Then, how can we consider this as reliable?
1
I must begin with my regrets for the horseshoe crabs whose blood is the key ingredient for the test strips, and for the few who occasionally die in the process.
People DO need to know how much or little they eat at different times affects their resulting blood glucose level.
I would guess that most patients could use three months' worth of testing materials every year to see how their numbers are going, but where does that ''most'' begin or end?
Whoever devises a safe system of appetite control will be able to have anything this world offers, and would need a computer to realize how many more years she or he gave these patients.
you can rest easy for the horseshoe crabs. :-) they have nothing to do with blood glucose testing. a drop of blood is pulled into the strip by capillary action, where it reacts with an enzyme and is converted to a molecule that can be read. horseshoe crab blood is used to test intravenous drugs for bacterial contamination, but not for blood glucose test strips.
I’ve had Type II diabetes for about 40 years and have used insulin for about the last 20, which I vastly prefer to pills. I check my blood sugar every morning just like I get on the scale every morning, just to see that everything’s stable and normal. The test strips are covered by Medicare and I do the same dose of long lasting insulin every day, though I have a vial of short-acting and know how to use it if I have an unusual spike, which would be due to an unusually big meal, which happens rarely. At the age of 72, my eating habits are simple and I don’t eat much, in the range of 1000-1200 calories a day, making sure to get about 60 grams of protein. A morning blood sugar reading is important for me because it can be low if I don’t have a carb snack at bedtime. Today it was 52. My remedy is 15 jellybeans for a 60-gram carb boost, then breakfast. I think it’s neurotic to adjust my eating every day based on minor changes in my readings. The fasting blood sugar goal is 80-120 and mine is usually 70-90. I sometimes check at night to see if I should have a small carb snack. A1c is always good. I weigh 50 pounds less than I did 15 years ago before bariatric surgery, and I also - finally - discovered a medical treatment for an eating disorder that I’d been plagued by for most of my adult life. I’m no longer neurotic about eating and my blood sugar testing is a useful tool. I have no diabetic complications.
6
Two thoughts: (1) Doctors don’t seem to recognize the anxiety that can develop over testing at home. For me, it’s the blood pressure checks at home that produce anxiety. (2) Sometimes, doctors work at odds. My PCP prescribed metformin to control my glucose; my cardiologist prescribed a diuretic that increases glucose as a side effect. The result? Ridiculously increased A1c. I can’t win.
6
I’m sorry you’re dealing with that. Just curious if you’ve tried controlling the diabetes through diet and exercise? I’m a huge fan of the documentary Forks Over Knives on Netflix. Watched it? It’s helped many people I know.
5
@Daniel and @Vicki
Agree regarding diet & weight loss. My husband changed his diet (on advice of an Internal Medcine specialist) to largely vegetarian plus fish a couple of days a week. This resulted in weight loss and easier exercise.
Our standard medical practice in our area is A1C every 3 months, no strips if stable. When my husband walked into the doctor’s office, after the quarterly test, for his checkup, he GP’s first words were”what are you doing differently?”
He was no longer considered a Type 2 diabetic!
4
So now what to do?
I stopped testing years ago. See my PCP every 3 months. Little or no change in A1C.
6
With an error range of 15% either way the accuracy of these tests leave much to be desired. For example, if the test shows you are 200, you could actually be anywhere from 170 to 230. The accuracy of the tests need dramatic improvement.
3
@bloggersvilleusa
Once you are getting HA1C's done periodically, you can relate the home testing to how it is all working. It's all about the trends.
Good luck!
When my husband was diagnosed with Type 2 diabetes his doctor recommended monitoring his blood glucose before and after meals. Many commenters have pointed out that for them this was an effective way to help change their behavior. But our insurance plan would only pay for one test strip per day, and it wasn't necessary to do a randomized, controlled study to quickly realize that this was useless. His diabetes, and his weight, was poorly controlled for years until we found a source of test strips that we could afford to pay for ourselves. With useful, real-time feedback he dropped 50 lbs from his 6'5" frame within two years, and his A1C is now consistently below his target level. Changing the lifelong habits that cause many people to develop Type 2 diabetes is not easy. Insurance companies shouldn't make it harder, and more costly in the long run, by refusing to cover the cost of monitoring. Perhaps Dr. Carroll could do a rigorous study to test the effectiveness of properly scheduled intra-day blood glucose monitoring for patients with Type 2 diabetes.
8
@Virginia
You could have used 2 strips a day on half as many days, and possibly gotten the same effect on diet. Did you try that?
I couldn't disagree more with this article and it worries me that it will take a valuable tool away from people with type two diabetes and pre-diabetes. Testing is extremely helpful. It keeps one out of denial and shows the effect, for example, of eating too many carbs. It is important to note, that except for extremely high numbers, there is no physical sign that tells you your blood sugars are high (for example 200). Also not all pre diabetics or diabetics are on medication but are using exercise and diet to control their sugars. Daily testing and adjusting one's behavior is much better than going many months until the next AIC.
14
Blood sugar testing and monitoring allows type 2 diabetics to use diet and exercise to reduce the need for medicine. But hey, if the objective is to sell more drugs, then get rid of the testing.
6
I agee. I'm Thpe 1, and most of the Type 2s I have observed seem to believe pills fix everything. I never observe them testing. These same people are not watching their diet or their weight. I prefer to have Type I because I have not been misled into thinking there will be no consequences as long as I take a pill.
4
"Of course, there are exceptions. When patients are acutely ill, or changing regimens, or finding that their blood sugar is not well controlled, testing may be appropriate."
Which begs the question, how do you know your blood sugar is not well controlled without testing?
11
Lifelong type 1 here (I'm now 71), also a lifelong food journalist. The comments here illustrate a common problem with health journalism, and medicine in general: patient knowledge is rarely tapped. Even if there's no skew from the drug industrial complex, the trials rarely go long or wide enough to allow clinical and treatment conclusions that work. My amazing endocrinologist works with me and all his diverse patients and listens to us, adjusting treatment to how we eat and live. Testing (any way you can afford), attention to what you eat, and willing to pay attention will keep T1, T2, T1.5s thriving.
5
I agree with the recommendations posited by this article. I have been prediabetic for over 10 years. My meds have been stable for years. Finger sticks did not seem to be useful after a couple of years. They added to my diabetes “fatigue.” Finally, I checked my blood a number of times with two different meters just to see what would happen. The readings were consistently 30-40 points off from each other. That tells me that these meters are doing little more than “ball parking” their results. I keep a meter handy as a just in case, but no longer regularly test.
2
@Harry M A lot of the meters are very bad. The government only requires a minimum of accuracy. This is scary (actually, very dangerous) for those who need to adjust their insulin frequently. I've used the One Touch Ultra and it gives the most consistent readings of the many different meters that I used over the years.
I am pre-diabetic and was able to get my A1C down to 5.4-5.5 from 5.9 by using the test strips and seeing how what I ate affected my blood sugar. I have stopped monitoring for about a year now and the AlC levels have remained in the normal range (though my fasting number is always a bit high). I think the test strips were invaluable to my making beneficial changes to my diet.
13
I disagree with your contention. It's misleading. I am a diabetic and have been on medication for about 9 years. I have observed over the years that the doctors always treat the symptoms and never help you address the root cause doing which can really help one lead a really healthy life. Whenever your levels are high they increase the dosage, which is seldom reversed, because it is believed that your levels stabilized not due to your control over food and exercise but due to the medication. This cycle gets regularly worse, meaning the patient spends more money on medication without any hope of becoming less dependent on medication. Increasing, continuous dependence on medication is assumed to be the inevitable norm. I have been able to prove this wrong by monitoring my levels at home as I experiment with reduced dosage. Positive results motivated me and I am achieving good control of my blood sugar levels through consistent exercise and diet control. It appears that doctors work for immediate results and hence treat the symptoms. They seem not to have the patience to work with the patients and help them gain fundamental improvement.
11
As a Type 2 diabetic I strongly disagree with this premise. Knowing how food and medication affect you throughout the day is essential to making good choices. These studies strike me as something funded by the insurance companies to create a precedent to justify no longer covering testing supplies. Follow the money.
20
When a T2 diabetic is on a low-carb or very low-carb (ketogenic) diet and is also on a medication such as metformin, blood glucose levels can get dangerously low. It happened to me more than once, and without monitoring my BG and taking action when it went below 60 I could've ended up in the hospital or dead. So, testing in the morning (once a day) if not on insulin might be useless, but postprandial testing at least once per day is definitely not, especially when on a low-carb diet. Also, if one happens to be taking medications that cause BG levels to skyrocket, such as prednisone, one NEEDS to monitor levels. I think the results of the test suggest 1x per day testing is useless UNLESS [insert one's personal situation here]. Blanket statements are dangerous.
11
Metformin rarely causes hypoglycaemia. If a type 2 diabetic on a low carb diet has low sugars, they are curing their reversible disease. They should be cutting down/ phasing out their glucose lowering meds (in consultation with their physician). Continuous glucose monitoring (CGM) is a smart way of receiving detailed and timely feedback during this process.
6
@JeremyS Metformin & low carb frequently causes hypoglycemia - it's a myth that it doesn't. CGM wasn't an option when I was reversing my diabetes and now is not readily available under most insurance plans in the US. Take a look at the T2 diabetes forums and support groups to find out what is happening in the real world.
4
This is a bit of ridiculous and unscientific advice stemming from a 12 mo study. No other nuances have been addressed and the experiments seem to be conducted by insurance companies and their cronies from the medical field. First, there are many diabetes medicines that lower the blood sugar too much or too little--not just insulin. Many other, unrelated medicines also have a sugar spiking or lowering effect on blood sugar--for example, Prednisone--a steroid given for severe allergies or asthma can do this. NY Times is outrightly irresponsible publishing such information.
12
@APS
The fluoroquinolones are a class of antibiotics that can also cause hypoglycemia. There are others, as well.
2
Unlike most people, I used the test strips not because I have diabetes, but because I am trying to avoid diabetes by watching my increasing glucose levels and compare it to diet and exercise patterns. It is definitely not the best system, between painful pricks, not getting enough blood, strips with short shelf-life once opened etc... But it does give me a rough idea at a low cost.
I am going to look into the continuous monitoring system mentioned by commenters.
I can't say what I would do if I were to have diabetes, but for my purposes, I find home monitoring useful
14
@lm
I do the same.
@lm
I do too, but I would never get a cgm if I did not have diabetes.
I was pre-diabetic, and used at-home blood testing to map my blood sugar response to foods, and gauge the effectiveness of exercise and dietary changes, allowing me to tailor a regiment resulting in me no longer being pre-diabetic. To say that blood-sugar testing is 'ineffective' because people who did it didn't have an effect on their symptoms is pretty unscientific. Where were the controls? In many cases diabetes forms because people don't respond to the numbers or don't check them.
20
Bad advice. Irresponsible. Whiff of malpractice. Daily tests provide valuable feedback. Diabetes is a "slow" developing disease. It offers an opportunity to make "corrections". Without feedback a gradual but regular "creep" in values will go unnoticed - and cause irrevocable harm.
23
@JMK
I agree that advising not to test is irresponsible. If testing doesn't make a difference that points to the fact that people aren't modifying their behavior based on the results. A different problem altogether. I am Type 2 and was on oral meds for years and now insulin for about 25 years. Either way, I test first thing in the morning and at least once later in the day. My results tell me how to plan or adjust my meals and whether I need some carbs before going to the gym. Testing helps me avoid low blood sugar episodes, as well as it serves as notice that I need to adjust my carb intake or increase my exercise. Yes, behavior modification!
1
I find that using a continuous glucose monitoring device for a week much more informative than testing once a day, which I no longer do. After all, I can test when I know my glucose levels are likely not high, and feel quite pleased. So far my glucose levels are tightly controlled, better than when I was just following general guidelines (diet, exercise, metformin, weight) recommended by my class and physician on managing diabetes2.
Yes the continuous monitor was not cheap, but the knowledge gained is allowing me to live a healthier life (more exercise, good diet and NO drugs with interesting side effects). I am deeply grateful to the dietician who suggested to our class that it was available for interested participants, although not required as part of the class.
I used one at the start of my treatment, to better understand my version of diabetes 2 and then 2 years later. It was pretty revealing about the kind of exercise == gardening and housework don't do anything for me, but 4 sessions of 20 minutes or more of quick walking, spaced during the day to keep glucose between 100-120 on the meter, worked wonders in my case, so long as I eat a low carb diet. It also showed me, that at least in my case, walking longer than 40 min, on metformin, managed to bring my glucose down to a hypoglycemic level of 40 (not supposed to happen on metformin). If anything, this finding was what spurred me to use only exercise, and not drugs, to manage my flavor of diabetes 2.
9
@Mary
Can you please let me know more about continuous glucose monitoring....like Brand,cost,ease of use etc? Thx.
Let me guess.
The pharmaceutical companies who produce the strips and meters have planted responses in favor of testing on this thread.
Try to pick them out. It shouldn't be that difficult.
9
There is a big difference in quality of life when you are constantly pricking your fingers to check your blood sugar. The results are possibly upsetting, and it hurts, and there is a risk of infection. The pain does not help. And having to prick your fingers when there are other monitors available is ridiculous. It's the same with taking your blood pressure. The results may upset you but there's nothing you can do about it but fret.
5
The article and study pose the wrong question and make the wrong conclusion. Finger pricks are outdated technology. Continuous glucose monitoring is a game changer with a powerful ability to change diets and behaviour.
Type 2 diabetes is a disease of carbohydrate metabolism. It is almost completely reversible.
Our food chain has been flooded with large volumes of cheaply produced modern carbohydrates. Most type 2 diabetics can get off all meds and live healthier lives when they stop pumping their body full of carbohydrates that they can not metabolise.
Instead of spending large amounts of money on drugs and test strips and specialists and managing complications, an alternative is this:
Wear a continuous glucose monitor. They give continuous 24 hour information without finger pricks.
Then eat your normal carbohydrate laden diet for a week. Have a look at your glucose response to various foods. Then go low carb for the second week. (Under medical supervision).
You will have a light bulb moment. There will be no going back.
Type 2 diabetes is a disease of carbohydrate metabolism. It is almost completely reversible
16
Bread may not be your life, but it is mine. I'd rather be dead than give up bread.
1
@rcongdon, I concur, I can relate to your post, it made me smile, love my breads with a passion but I have modified the portions, the kind of bread and flours I use to bake, add walnuts and seeds to my breads, whole grains, rye, sourdough are better glycemic wise. Takes some research to figure it out. Basically the closer to the natural product with the least processing the healthier. Whole oats rather than steel cut, each manipulation/processing has consequences. Most info out there is for people who eat out of a box, freezer section or at fast food restaurants. Also new info out there that low fat may not be the best for BS control. Hard to stay informed with the rapid changes in treatment trends. Being an RN I am keenly aware of the bodies complexities and that this is a very individualized disease so following on-line advice (including mine) is dubious. I am lucky enough to have an excellent and up to date physician who is working with me to get my DM2 under control. Just wanted to comment that you can most likely modify your approach to bread and still enjoy the quality of life you are accustomed to.
I have a PhD in molecular biology and have Type II diabetes
This is dangerous nonsense, all the more so because it is half right
Type II is a individualized disease
That means that you have to tailor the therapy to the patient
If MDs are unable to do this, because insurance companies restrict their time, then MDs should step aside and let people who are more competent do the job
In particular, A1C doesn't measure swings, esp after eating, which may be more imp for some people
also, this is so important: in most cases typeII is a lifestyle disease; the NIH spends way way to much on fancy molecular research and way way to little on lifestyle stuff
As a scientist, I say this only half in jest: if Type II patients got together and threw a temper tantrum each time the office had free donuts (that is free heart disease diabetes and obesity) I bet this would do more for patients then drugs
7
As a practicing endocrinologist I do think this article is somewhat outdated not to mention CGM (continuous glucose monitoring). Most of my patients use this without the hassle or pain of having to prick their fingers. It has changed my practice so much for the better, and patients can seeing exactly what certain foods do to their body rather than the limited knowledge that something is simply bad for them. I also agree with another comment posted that most of these medical articles are so generalized. No two patients are ever the same. Diabetes does need to be monitored, especially when drugs are changed and with so few patients actually at goal. It is paramount to remember uncontrolled diabetics often have few symptoms until sugars are quite high. I suspect it would be the insurance companies who would rejoice the most with such generalized/ misinterpreted articles, to allow them to refuse to pay for one more thing. These decisions should be made between the doctor and the patient.
15
I am currently using a Free Style Libre to keep track of my diabetes 2 without a finger prick. It's expensive and not as accurate as a finger prick would be, but I like it because I feel it helps gives me better control over my diet.
And no, this is not a a paid advertisement for them.
5
... over my diet and sugar intake.
3
I’ve been a Type 1 diabetic for ca. 40 years and have stayed healthy largely because of vigorous (10-12 times a day) testing. I’ve recently switched to a CGM system that has been a vast improvement both for it’s ease of use and the improvement in A1c’s. The fact that it’s a continuous (a new reading every 5 minutes) readout helps address low and high trends. (Try testing with strips on the street on a freezing day when you suspect your BG is dropping.)
I think the real issue here is why this business is so expensive? (As much as $1.75 per strip. Really? What’s your best guess as to what they cost to produce?). I can’t speak for the ebb and flow of good sense control in Type 2 diabetics, but I can’t help but think that more information is always better than less. There is a diabetic epidemic going on in his country and, as usual, Big Pharma is taking advantage.
10
Glipizide can bottom you out much like insulin. I would not recommend that a patient forgo testing with glipizide, unless he/she has above average awareness, eats pretty much the same thing everyday, and has not had enough hypoglycemic episodes to blunt the awareness of low blood glucose. Glipizide can be a very dangerous medication.
I was diagnosed as a type 2 diabetic 15 years ago. I have not needed to take insulin. The blood test helped me learn how different foods affect my BSL, and helped me develop an effective meal plan, which is the major factor in my controlling my blood glucose level. The discipline to stay on a healthy is of course the most important element.
12
I had diabetes in pregnancy and learned how to test my blood sugars.
I learned a great deal about blood sugar and diet during my pregnancy. I also went to diabetic meal preperation classes.
By diligent testing, recording and food selection, I was able to avoid needing insulin.
The insulin tests were crucial in my control of diabetes.
It was very interesting to see how quickly and how poorly I responded to sugars and carbs in my diet.
People should test because there are individual differences in how people respond to foods (based on the condition of their pancreas).
5
Daily monitoring is worthless ONLY if the patient does not change food choices, exercises, etc. Some folks think that merely popping a metformin pill is sufficient. Metformin usually doesn't have hypoglucemia effects like insulin BUT daily testing results in combination with A1C tests, improving food choices, etc. can improve glucose swings!
I test every morning and use the results to monitor and improve food choices, exercise impact, and to get detailed data when my metformin dose was changed. Working hard to get a daily fasting glucose level below 110 and even 100 has caused me to get my A1C below 5.6 for 4 years now and totally avoid being put on insulin!
So what if it costs $300 to use glucose strips--that is priceless compared to thousands of dollars for high-cost insulin, hospitalization, neurothropy, amputations and the downhill spiral of uncontrolled glucose levels!
22
FYI. My A1C readings were creeping above 6.1, six years ago. As a careful scientist, I got two glucometers to handle reading +/- tolerances and started my fasting and 2 hours post-eating glucose for 2 months. I gave my doctor showed the data table and graph (!!) and told her "Forget this pre-diabetes nonsense! I know I have diabetes since my younger sisters, mother, all my aunts all are insulin-using T2Ds!" I demanded to start taking metformin asap since it is also heart-protective. My mom died at age 51 when it was NOT available in the US! Both my sisters started insulin at age 40! BTW, my sister, a Registered Nurse stopped taking insulin, metformin, taking glucose and a1c tests 4 years before she DIED of kidney failure and heart disease in Nov. 2017. Her last A1C was 13+ !! She knew better than anyone what uncontrolled diabetes because she worked at county-owned hospital with hundreds of diabetics! My other sister, her identical twin is still alive, on insulin and metformin but her A1C is still above 9! Having watched diabetes complications in friends and family, I am extremely glad that I test daily, watch what I eat (100 or less net carbs daily) exercise, get A1C tests. etc. so I don't have to use insulin. I would suggest everyone to read Dr. Jason Fung's books or see his videos about diabetics adopting a low carb diet for lowering blood sugar. His premise is that doctors are pushing INSULIN, treating diabetes incorrectly, vs. solving the cause.
9
Only a year? Using the same, narrow parameters of so many PCP's: fasting glucose? Oh, the wasted years docs spend trying to achieve control without the right data and immediate follow-up that home glucose testing allows. Oh, the YEARS of inflammation my patients' bodies endured being told by doc to go back to the lab in 3 months after a modest dose increase and a lecture on lifestyle changes, and A1C remains high or climbs while preventable hyperglycemia goes undetected and unaddressed by higher oral doses or insulin. Diabetes progresses - glucose levels get harder to control as time passes, and the more poorly controlled, the faster the progression. A1C's detect chronic hyperglycemia, but its just an average. Sure, send 'em to the lab every 3 months alone or give them a meter and tell them to test once a day in the morning and end up with similar outcomes. OR you can do what I do and find out what their sugars are running fasting, post-meals, and maybe at bedtime. Not forever. Maybe just for a week or two or three. They SEE what cereal etc. does to their blood sugar, see that bg is high all day and maybe high at bedtime and then misleadingly A-ok after a night of endogenous insulin secretion bringing down their number to a nearer normal range (and thus taxing their pancreas with extra work and progressing their diabetes even faster). This data can be acted on sometimes in mere days, avoiding three months of hyperglycemia. Its what the provider and patient DO with the data.
18
The Monitor trial report in JAMA actually states (secondary outcomes) that insulin initiation among those who did not test was 8.6% vs 4% (test only) and 5.4% (test with feedback) in those who tested. It also showed that nearly half of those on the arm for testing with feedback stopped reporting / testing by end of the 12 month period, presumably because they found the testing and the robotic feedback messages not useful. Even then, during the first six months when the testing compliance was higher, the mean HbA1c dropped from 7.5% to 7% before rising back (Fig 2). Most of the participants in the study had diabetes for many years (median 6 years), so the trial did not inform initial adjustments to therapy and lifestyle changes.
HbA1c gives average value of plasma glucose over a few months rather than the hourly or daily excursions. Damage to organs from uncontrolled blood sugar is more strongly associated with hourly and daily excursions than with the average from HbA1c.
10
No one is talking about the criminally high price of insulin. My copay under the Federal Employee Health Benefit Plan went from $10 for a 90-day supply last year to $300 this year. I take two types of insulin and trulicity (a non-insulin injectable), for a cost of $3600 per year! That’s an increase of 2900%!
The problem seems to be with the for-profit pharmaceutical manufacturers in collaboration with the for-profit insurance companies. Why should others be allowed to profit off my pain and suffering?
Make insurance companies non-profit, and watch costs fall with new advances such as continuous glucose monitoring systems and insulin pumps finally becoming affordable.
40
I test every morning. Its mostly to provide reinforcement to my efforts to maintain a healthier diet and some exercise. And when the meter says I have behaved, I subsequently get a good A1C result, and when I have not behaved, the A1C turns out less good. So I think testing is useful to me.
What Medicare pays for those test strips is criminal. It is preposterous that Medicare cannot negotiate prices on such supplies.
a
27
Every two months my nephrologist check my blood sugar level. At one point I was told by my doctor that i am prediabetes. A person I know ate a lot of pasta everyday. He told me that his doctor told him to exercise daily and to eat a lot of dark green vegetables. I started to eat dark green vegetables everyday such as baby spinach and other veggies. I am now out of the prediabetes range.
15
I am for 37 years diabetic 2 with controlled blood sugar. I test once a day in the morning and record the results on a spread sheet. This enables me to see my sugar and relate it to the main meal I had the evening before. I can note which foods raise my sugar and which do not. My last 4 A1C tests were 5.6; 5.4; 6.1; and 5.9. When I know I will eat something "bad", I take an extra pill or two to offset the effect. (I take Prandin for that.) I also take Precose, but only ever 1 pill before meals. I know that once a day is not "perfect" and does not account for blood sugar during the day, but this works for me and low A1Cs after 37 years is pretty good and I eat well and within reason.
8
I think we need to follow the money in this case. My wife's A1C was high - doctor recommended not getting a meter. We went right out and got a meter. A great deal of useful information was obtained by testing after different meals. My wife altered her diet and brought her A1C way down - now it's perfectly normal on no drugs. Key point here - no drugs. It hasn't been clear to me why any medical professionals would be suggesting that not metering is a sensible approach?
44
Sounds like losing 50 pounds is the answer here.
@Sarah99 - And what will that do for the 20-25% of type II diabetics that are lean?
19
@Sarah99
Oh, Sarah, do tell. We'd all LOVE to hear how that's done and how that weight is kept off. Please, elaborate.
4
@Sarah99
I am very athletic and still in great shape at 57; I exercise regularly and eat heathy- and I am pre-diabetic. My overweight brother had Type II and died of heart failure; we said the same thing to him: lose weight. But now that I have it, I know it is genetics at play. Being overweight exasperates the problem, but don't make the mistake of assuming all diabetics are overweight!
3
My mother used to check her blood sugar levels every morning. She did not take insulin; she did take Glucophage, I believe, a prescription med administered daily. I used to ask her why she took her blood sugar every morning and she said, "The doctor told me I had to." I asked her what she was supposed to do is her numbers were irregular. She shrugged. Sounded like a waste of time to me, and as for the pocketbook it was a huge waste of money. The needles you have to purchase to stick your fingers with to take the test are very expensive. You must have a doctor's prescription for them, and the insurance company will not allow you to get a refill until you are down to five days' supply or less.
If the end, she did not die from diabetes - she passed away penniless in a nursing home. The money she spent on those needles could have been used to buy herself more nutritious food, which is something she would have benefited from in her golden years.
12
@Larry
You do not have to have a prescription to get a meter, test strips or lancet (those tiny needles!) You can go to Walmart and get them OTC very cheaply. Amazon is even cheaper! Lower than any co-pay insurance or medicare benefits.
2
@Larry
I'm sorry for your mother.
"The needles you have to purchase to stick your fingers with to take the test are very expensive. " The needles (if they are the ones that have a pen to use them in) can actually be reused and are frequently reused by diabetics. It is the test strips that are very expensive, but you can actually purchase them without insurance. They aren't cheap necessarily but the prices vary wildly and you can occasionally find a good deal on them.
It sounds like this article was written for people like your mom.
1
No mention of the patch? Or did I skip past it?
The fallacy of this study’s conclusions is in deciding there is no value to home testing, rather than concluding there is no value in home testing IN THIS WAY. A better conclusion might have been that neither A1C levels nor single-test home tests are good ways to monitor diabetic progression if the goal is having individuals make changes to their behaviors that may contribute to their disease.
As others have pointed out, once-a-day testing is virtually useless for tracking how one’s diabetes is progressing. Multiple testing, particularly related to after-meal changes, is the best way to measure how effectively a treatment method is working. Continuous glucose monitors are enabling type-2, non-insulin dependent diabetics to better monitor the effects of their eating and activity on their blood sugars and helping people make real-time changes in their behavior as a result. It will be interesting to see the studies done on whether this type of testing affects A1C levels better than test strips.
Determining which behavioral changes and treatment options work best for each diabetic, whether type 1 or type 2 requires more individualized information, not less. CGMs can help provide that info, just as using test strips multiple times per day, especially related to meals, can give patients a much clearer sense of what their bodies are doing with the insulin they still have.
21
I use and recommend 4x daily testing before eating for Type II diabetes in order to determine FOOD GROUP sensitivity, and in order to make better choices on which foods to eat. I am now able to enjoy an occasional glass of beer (Guiness), and often partake of sweet potatoes as snacks because I could consistently determine how these foods "burn" in my system. This has enabled me to lower my drug usage, and avoid insulin altogether. NO one should ever tell us that we are all the same, and that we must manage our diabetes with the exact same medications and food choices.
26
Your summary article failed to address the issue of overpriced test strips. Some brands of test strips have a retail price that can easily cost $100 a month or more, and discount brands like Wal-Mart's Relion only cost about $20 a month. Much of the pragmatic cost and benefit concerns could easily be diminished if more of us would stop buying overpriced name brands. Insurance companies, Medicaid, Medicare, and Tricare also need to stop subsidizing high priced name brands and offer coverage for lower priced brands. Or better yet, just give every diabetic patient a flat rate allowance of $50 a month and let personal money-saving incentives create competitive pressure to bring the prices down.
11
Expensive test strips are a goldmine for pharma. Many low-severity diabetics test and test just to see the same results day after day. Just cut out carbs and sweets and try to keep the weight off.
22
Many problems with type 2 diabetics arise from the fact that they're largely non-compliant with dietary advice. Since that type of diabetes is related to obesity, if type 2ers followed a strict diet many could cure themselves with weight loss.
A1C is one metric, a long-term average of blood sugar. But that doesn't mean that wild swings in blood sugar levels by those who overindulge in sugar and/or calories don't suffer harm over the years.
Btw the obesity epidemic with its attendant rise in those diagnosed with type 2 diabetes, hypertension, hypercholesterolemia, and arthritic symptoms- combined with Big Pharma's constant push to increase the price of the pharmaceuticals they market towards these conditions- might just be the fatal blow that tips us into financial insolvency as a country while Big Pharma rewards its shareholders and executives.
2
The doctor did say testing is important when ill, when decreased food intake and stress exert different pulls on the blood sugar. What is really important is to put more effort into exercise than routine blood sugar testing. Working out with weights is supposedly beneficial, aside from aerobic exercise.
5
My doctor only looks at the A1C test once every three months. The results of daily early morning sticks are ephemeral, based on what I ate the night before and on how much glucose is kicked out by my liver first thing in the morning. If I stick as soon as I get out of bed I see one result.If I then wait 20 minutes and try again I get a different number, sometimes10-20 more.
7
There was a point where I stopped checking blood sugar every day. Then one day when I was feeling peculiar I did the test, and the glucose reading was sky-high. I got an emergency doctor appointment and they used insulin to bring the readings down. Turned out the problem was my usual diabetes drugs weren't powerful enough and the dosages had to be raised.
16
That study didn’t prove that home testing isn’t helpful, it proved that testing once a day, first thing in the morning, isn’t helpful. From my own experience, the fasting blood glucose number that I get when I wake up in the morning is the least interesting number all day. There’s little I can do to make it change, except for long term diet and exercise.
Testing 2 hours after eating, though, tells me how that meal I just ate has affected my blood sugar. I can use that information to make specific changes to my diet to control blood sugar spikes. Using diet to keep my blood glucose in range all day keeps me from needing to take medication, saves me from complications related to high blood glucose, and slows the progression of the disease.
59
@Ann P.
Agreed! the morning dump of glucose by the liver into the bloodstream makes my morning fasting test routinely higher than one might expect- so I skip this test. Unless you are someone who uses the feedback from the daily test to alter your diet, as we do, you really won't understand the value of testing.
3
These study merely reflect the gross ignorance of the diabetic population. And the inability of the medical profession to do anything about. Diabetes is a disease that can be controlled, but the control must come from the individual that has it. Glucose monitoring is a mechanisms to help in its control. You can regulate you diet better and your medications better. But you have to be educated properly to do it. I know I have been a tightly controlled type 2 diabetic for 40 years without any draconian side effect.
26
@Oliver
I concur with your comments. Since the day I was diagnosed twelve years ago I have studied my condition of Type 2. I am still learning more about control with diet and testing daily is imperative as far as I am concerned.
Most newly diagnosed diabetics do not know that they must immediately learn nutrition, portion control and self control. You made it happen; I made it happen. It can be done.
7
I think this article is utter nonsense. While I adhere to a dietary and drug regimen that keeps my blood glucose levels from seldom rising too high, certain activities like vigorous exercise and drinking wine can, in combination with my prescribed medication, take it too low. I have no way of recognizing this condition, and compensating for it with some candy or a glass of juice, without a blood glucose test.
And sometimes it DOES go too high, and this condition is more difficult to recognize from its symptoms than the times it goes too low (which sometimes causes sweating and shakiness). When it goes too high, I take an extra low-dose tablet of Metformin, mainly because when it shoots too high it does damage to my retinas. But again, I would not recognize the condition without a blood glucose test.
I know some people are always trying to reduce the cost of health care, but I would urge it not be at the expense of effective treatment.
26
@Dr. PlanarianIt's not only about you, doc. That can be hard to grasp, since you may be one of those guys who sees everything reduced to how it applies to you. Take another look at what was written in the article. Parts of it are about you; try to see the other parts.
2
I am a T2Diabetic who just started using the Freestyle Libre 14 day sensor to get some feedback on how what I am eating affects my blood sugar in real time.
I consider it a game changer and as I am seeking to lose weight with Weight Watchers, finding out how the WW recommendations affect my blood glucose will be important. My husband has also decided to try this monitoring system (also T2DM) to see how his lifestyle affects his blood glucose. Hoping the feedback incentivizes better food choices and more exercise.
10
Two questions: First, Why in the world would you use a photo showing filled vials of Humalog insulin in an article trashing the use of at-home glucometers and test strips for non-insulin dependent diabetics?
And second, can you identify a single endocrinologist, or for that matter, a single diabetic who would argue that there is no value in knowing his/her blood glucose level? The real objections are primarily, if not exclusively, economic. Test strips are ridiculously, and indefensibly overpriced. The problem isn’t unnecessary testing. The problem is greed.
68
@Mike LawlerRight. Why is it so difficult to make the world know that in medicine greed is not good, it's criminal.
9
@Mike Lawler. I was diagnosed with type 2 Diabetes 13 years ago, age 66. Hate self administering needles of any size. Made a deal with MD: PLEASE GIVE ME SIX months to try diet and medicine. Lost 15 pounds then. By now have lost 70 pounds. Still managing with healthy diet and meds, esp Metformin. I agree knowing daily blood glucose level. My MD agrees.
3
Jees.....it is not rocket science to improve our overall health. To all type 2 diabetics out there,
Please stop consuming all processed plants and all sugars (this includes fruits). Continue for 3 weeks and watch your blood sugar levels normalize, blood pressure normalize and overall health improve. Continue for 6 months and notice fasting insuline levels drop to a normal range.
It makes abosolutely no sense whatsoever to give a type 2 diabetic insulin injections. The problem is too much insulin in the body.
3
@Alexis Crawford Type 2 diabetes is a much more complex disease than you portray. First, it is not necessary to avoid all fruit in Type 2 diabetes. Fruit in moderation is a healthy part of meal planning, and includes important fiber and phytochemicals. Also, Type 2 diabetes is a disease of insulin resistance. While some people may generate extra insulin to compensate, as the disease progresses, many people make less and less of their own insulin--thus do require insulin injections.
7
@doctort20000
Or they could be like me ... controlled my T2 with meds & diet until a bout with pancreatitis fried my ability to produce enough insulin.
1
A regular (once a week) glucose monitoring home test is essential for people with type 2 diabetes who are not on insulin until they have established a routine sugar free, low fat low card diet and physical activity that maintains normal blood glucose levels. For people with type 2 diabetes, maintaining normal blood glucose levels is very critical to prevent awful diabetic complications. Millions of baby boomers and senior citizens in America are very sick and the incidence of any of the number of potential complications from diabetes is very high and costly.
Anyone who is meticulous in monitoring blood glucose and trying to hard to control blood glucose should be encouraged to keep doing whatever they do to stay healthy. My father who will be turning 100 in a few months had his blood glucose levels below 100 mgs/dl for most of his life until he turned 99 and had no complications that are associated with abnormally high blood pressure. Point is if you have type 2 diabetes go overboard to do whatever it takes to keep normal fasting blood glucose levels. If doing a routine glucose monitoring especially if you make changes in your diet or physical activity is what you feel you can do, just do it. Don't be a statistic with diabetic complications. Life with diabetic complications is a lot harder. I dread its onset every hour of my life. I also warn those with type 2 diabetes that whether you have complications or not you will have difficulty getting term life insurance.
13
So let me get this straight - you don’t test yourself, you have no idea what your blood sugar level is, and that is going to help you? How? How are you going to know the effect of food on a day to day basis without testing? How are you going to be able to change your behavior before getting an A1c that is through the roof without knowing what your blood sugar levels are?
I think this is all about getting more people on insulin because “they can’t control their diabetes “. Blood sugar monitoring puts YOU in control and not your doctor and not the pharmaceutical companies. I don’t believe this so called “study”.
34
Nancy’s sister came to the same conclusion. What is the point? It’s the A1C that matters, if that’s reasonably ok it’s not like the blood sugar is going to plummet in a type 2 not on insulin. A big waste of time, money and needless lancet poking.
6
@Nancy Rockford, my A1c levels are generally good but I do glucose testing in between A1c because I have noticed spikes in my blood sugar readings. Often it is hard to correlate the high levels with what I have eaten because high levels aren't necessarily when I have splurged on carbs or sugars. If I notice high levels though I can closely monitor what I eat for that day. It is useless only if you don't make adjustments in your diet.
1
I was diagnosed as diabetic over ten years ago; I am now 76 YO. I test twice daily, more if unusual readings indicate spikes. I adjust diet to the readings, and log all readings, along with BP, weight and heart rate.
Typically my A1C runs 5.5 to 5.9. I take Metformin (which be helpful for indications beyond diabetes) Both my cardiologist and my internist are highly supportive of this approach. I deliver my tracking data to them at 90 day intervals for the internist and 180 day intervals for the cardiologist.
I agree that testing without doing more is a waste, but testing as part of a disciplined protocol works very well for me. Reading weight without acting on the result is a waste as well; that seems widely popular.
11
The doctors told me I was diabetic and I ignored them for years then and event occurred and I bought a monitor and saw that they where right. I check my blood sugar every day and no one pays for the equipment but me. I changed my diet based in no small part on that monitor. I can see clearly how what I eat will effect my blood sugar and no doctor will do that for me.
This article is dangerous. In a society like ours where sugar is the drug of choice a monitor is essential for most people like me.
32
I have type 2 diabetes and find the daily blood-sugar test to be quite useful. It shows me that my medication is working by displaying (usually) a consistent (± 10) reading every day. At the same time, if I sense a low blood-sugar situation, a quick blood-sugar reading can either confirm that my blood-sugar has indeed dropped inexplicably low or that something else is amiss.
7
@Matt GaffneyYes, but what this article points out is that you are wasting money: IF, after doing all that testing you know what the answers are going to be tomorrow, then you do not have to test tomorrow.
1
Clearly the person who wrote this article is neither a diabetic and not very well informed about diabetes.
As an insulin dependent diabetic for more that 24 years, it's clear that having at least 4+ readings a day will help the real individual know how his/her blood sugars are overnight, after meals, when they are hungry, after exercise. Any real diabetic will tell you that there is valuable information in understanding the trend of your blood sugars and then you can figure out what to actually do about it.
the problem is that most doctors and nurses or techs don't think about what the patient in front of them really needs, but because they (Dr.s, nurses, techs) don't get paid to do anything other than process patients through the mill.
we diabetics need to educate ourselves. It's sad to see someone with a prestigious title write something that belittles the intelligence of those they are charged to help....
10
@Neil RYou of course are right about what is right for you. But I think it is fair to say that this article is not completely about people who are insulin dependent, daily users of insulin.
1
I’ve been technically prediabetic for my entire adult life, with blood sugar between 100 and 115. My doctors conclude that is normal for me. A1c is between 5 and 6.
My cholesterol is always 200 to 210, no matter what I do. My doctors conclude that is normal.
I feel fortunate that I have doctors who do not feel the need to over medicate. I’m not jabbing myself to monitor my sugar intake, I’m not taking Lipitor and other meds and having to cope with side effects. I eat properly and exercise. I’m heading into my 65th year. So far so good.
11
normal doesn't mean optimal. blood glucose in the non-diabetic range (A1c below 5.7, but optimally lower, in the higher 4% range)
As a person recently diagnosed with Type 2, using a glucose monitor was so useful for me in the beginning. Frankly, I diagnosed myself based on my symptoms (unexplained weight loss, thirst, frequent urination etc.) I quickly bought a monitor on my own and confirmed it. Having this information on hand at my first primary care appointment and in the first days and weeks as I adjusted my diet and started medication was essential. Articles like this can be so dangerous to someone who is focusing in headlines and soundbites. It is true that I do not test myself every day now that my condition seems stable. I figured this out on my own after my levels came down, normalized and stayed there. I'm 2 months in and I test once a week on my own and in fact just saw my doctor for my latest A1C check. But if a patient with a new diagnoses goes on medication and is obsessive about eating an extremely low carb diet, sugar levels could swing the other way and become dangerously low. Not to mention those who would prefer to treat their diagnoses with diet alone. Having and using the monitor is an amazing tool in these circumstances. Sidenote. I received my current insurance through the Healthcare.gov Marketplace as a new enrollee this past January. Without insurance, this could have been very expensive and much more stressful than it already is.
13
Personally, I think most people that consume the typical western diet should check their glucose levels pre/post meals, especially if pre-diabetic(fasting glucose 100-125). This could keep a person, if measures are taken, from becoming a type 2 diabetic. It could also serve to alert you to foods that you need to avoid or consume in moderation.
5
I'm a type 2 Diabetic who has been diagnosed for 7 years.
In the first month after my diagnosis I bought myself a test kit. And used it frequently to better understand what my blood sugar was doing. I was testing 10-20 times a day or more for a couple of weeks. (Before eating, 1 hour after eating, 2 hours after eating, 3 hours after eating, getting up in the morning at the very least.) As I did I learned a lot about my sugar readings and how I was feeling. For a few months I tested regularly, and in the process learned what different blood sugar levels felt like.
I still have the test kit, and I keep lancets, alcohol swabs and test strips with me, but I'm only testing a handful of times a year Usually when I feel weird or am otherwise concerned. I tested a few times while prepping for a colonoscopy to see if drinking some sugary things was disrupting my blood sugar control. (It wasn't which was reassuring.)
I find I still have a pretty good idea of what is happening to my blood sugar based upon how I feel. I learned that by repeated testing for a few months after my diagnosis with Type 2.
7
Pre-diabetic since 2012.
The value of home testing to me was to see the effect of various foods on my blood glucose levels.
The test itself isn't going to control blood glucose. It's a test - not a treatment. It's what you do once you have the test results that counts. This is a good example of Knowledge is Power. If you know what your glucose levels are you can do something about it - like figure out a diet. If you don't, it is much more difficult. You can get a monitor for less than $20 and strips for less than 20c each. So you can test daily for around $5/month.
16
I am a 63 year old female with Type 2 Diabetes, and it is the Home Testing much more than the semi annual a1c which has shown me how my diet choices affect my blood sugar levels.
Now I am on the Keto diet, which I strictly adhere to and I have been able to cut back on my insulin to where some days I do not use it at all because when I do use even a minimal amount it causes hypoglycaemia ... I do take all my pills however (Metformin, Januvia, Invokana) but I also avoid fried foods, pizza, sugar, bread and rice. My blood stays balanced as long as I do not cheat! Keto has been a godsend to me!
9
I am mildly diabetic and I don't test at all anymore. Once testing indicated what I needed to do---walk and eat sensibly, I figured I didn't need to do it. I imagine it could help motivate me, but . . .
3
The article just demonstrates why for-profit health care is so inefficient.
Health care decisions should be made pursuant to expert standard of care medical science. Interjecting individual coverage considerations and ability-to-pay just leads to inefficient outcomes.
It makes about as much sense as leaving snow plowing up to individuals.
1
Great synthesis about a vexing issue of diabetes care. As a primary care physician, I have many patients who have been trained to check their BGs daily, usually first thing in the morning, even though nobody is using the results. I also have as many patients who have been trained to never check their sugars, instead relying on 3-6 monthly a1c blood tests. Both situations have me smacking my forehead.
When patients check their blood sugars, ideally 90 minutes after eating, they get something valuable and rare in modern medicine -- immediate, personalized feedback. In this way, patients can make small changes to their lifestyle and observe the results. When this works, it is many times more powerful than the best diabetes medications. It's not right for everyone, but millions of patients are missing the opportunity to achieve better clinical outcomes without side effects or complications, because the health care system is ill-suited to highly personalized and patient-driven care plans.
Instead, we see patients every few months, check an a1c to gauge the past 3 months of blood sugars (usually naive to the many shortcomings of this test), tweak medications, and advise sternly against carbs. This approach virtually guarantees mediocrity in outcomes, but more importantly, it deprives patients the chance to learn to improve their control through small, highly-individualized tests of change.
71
@DanBut, doctor, didn't this article say that studies have shown that less testing makes sense when and if the patient knows from experience what his BG is WITHOUT testing, or with less testing?
3
@Dan
My nutritionist gave me a bunch of extra strips to use when I was first diagnosed and that let me test after meals to learn what I could eat and the amounts I could eat. Once I ran out of those and only had enough strips to test once a day, I gave up testing entirely.
One or two strips a day is useless, we need to be able to see the results of our actions. I was much more motivated when I could see that feedback.
4
@Leojv, as a Type2 diabetic I can tell you that I don't know from experience what my BG level is. I don't feel any different either. Mine fluctuates but my A1c levels are usually good. It is only by testing that I know what my BG levels are. My levels can be as high as 146 or as low as 90. I have to adjust my diet accordingly.
2
Test is useful if you're trying a low carb diet to bring weight and glucose down. It's nice to know what's causing those 90 point downswings that leave you lost in space.
The strips work well if you're doing things, and need a diagnostic tool to see the results, but testing once or twice a day for no particular reason is a waste of money.
15
I taught pharmacology to two generations of physicians. As a diabetic I learned more from those in the field planning to keep in touch on their latest research than from those in practice advising me. Certain ingredients such as molasses, cornstarch, frosting and powdered sugar cannot be properly controlled by any existing form of insulin other than temporarily lowering blood glocuse ranges out of the danger zone hence are best avoided.
4
There are some folks who would be advised to monitor their blood sugar levels.
As a person who had type 2 diabetes, my experience may be helpful for others in my situation. I live alone, and don't have anyone to keep an eye on me and my diet. I sometimes have a problem with depression, and in those times I am likely to eat the wrong kind of food, and in quantities that raise my blood sugar.
I experienced a rise in my blood sugar from 6.1 to 11.8 in the span of about 2 years without realizing it. If I hadn't been told to stop my blood sugar testing by my Dr., I would have seen this rise happening and responded to it.
As soon as I realized my blood sugar had skyrocketed, I went on a serious diet (cut out most of the carbs, and started intermittent fasting), and lost 30 lbs in about 5 months. My A1C is now even better than before, last time I checked it was 5.5, which is in the pre-diabetic range.
If you live alone, and don't eat a regular diet, I would suggest that continued blood sugar testing is a wise choice.
33
If blood testing leads to nothing more than a collection of data, then, sure, what’s the point? But as some commenters note, test results can be used as a guide to changes in life activities or therapeutic regimens.
Collecting data for the sake of collecting makes no sense. Collect stamps; it hurts less.
Using test results – especially multi-day (or longer) trends – to guide changes in behavior seems to be a pretty obvious and sensible aid to helping people manage this largely symptom-free but insidious condition.
7
I think these home glucose monitors have their value, specifically to help keep prediabetics from developing diabetes and to keep non-insulin dependent diabetics off insulin. In 2006 I discovered I had prediabetes, thanks to a pre-op nurse who actually scrutinized my pre-op labs. I was otherwise healthy but my health provider said that if I continued to do nothing, my condition would likely progress to diabetes within about five years (complications from diabetes killed many of my family members; most were under 60 and two had limbs amputated). She recommended I monitor myself at home and said my best chance to avoid diabetes would be to live & think like a diabetic. That glucose monitor was the best money I ever spent. I could see how different starches affected my blood sugar and the impact of exercise. It helped me select portion sizes and has helped me select the best grains for breads (spelt has been promising) and has shown me a square of dark chocolate is much better than a cookie. My monitor helps me test and modify recipes. I believe everyone diagnosed with prediabetes should be given--yes given--a glucose monitor and enough test strips for a month or two to help them develop a diet and lifestyle that works for them. So even though I felt I was healthy, the glucose monitor showed me I had to work a little harder if I wanted to stave off the disease that has killed, impaired, and impacted so many members of my family. Where's the harm in knowing that?
95
This comment is a perfect example of the writer's point: the smartest spend, and biggest bang for the buck, would be to give every type 1 diabetic a continuous glucose monitor. Type 1's present a much greater risk of serious health issues in the absence of the data provided by the CGM. Type 2's can, in the absence of CGM data, can have great health outcomes by improving diet in general and getting exercise.
Been a type II diabetic for almost twenty years, A1C every six months, usually in mid sevens; With Drs. Ok I only test when I find my self getting sloppy with exercise and diet. Testing seems to get me back on track and disciplined. As I get older find it harder and harder to stay in limits
29
type 2 diabetes is progressive unless you can keep your blood glucose within a normal, non-diabetic range: A1c below 5.8 and some would say lower is actually normal because folks with A1cs in the 5s usually have some insulin resistance or other impairment going on.
Welcome to our de facto criminal for profit health care system.
It is like the boy that cried wolf syndrome. When science comes up with something that works, many people don't believe them because of useless tests like this.
4
@Paul, don't believe everything you read. BG testing is useful to many people and I am one of them. I don't test everyday religiously but I do often enough to know that my levels can fluctuate. When levels are high, I check for a few days to be sure I'm on the right track.
2
@Katherine Cagle-thank you for your reply.
If I read you correctly you are sort of agreeing with me. Educate yourself and decide whether what the doctor is saying is a rip off or worth it or a combo.
Institutions like the NY Times especially Jane Brody types can be very useful and objective but big hmo and big pharmaceutical are lurking in the background to rip you off.
1
I have been a type 2 for 33 years. I have never been a blood glucose tester. When I was diagnosed the threshold for A1c was 12. Now 6 or so is the standard. I watch my diet, stay active, and have my A1c checked every three months. My A1c was 7.3 last time. My doctor and I are both pleased with my result. Paying close attention to your condition is absolutely necessary.
7
In the next few years, test strips and glucose monitors will become extinct. Patches to monitor real time blood sugar will and should become inexpensive - doctors and patients will have accurate data on what cause blood sugar spikes. I use a blood sugar monitor but I am not a diabetic. I learned quite a bit how foods affect me specifically all sugars and carbs.
The real geniuses at big pharma would be the ones selling patches, and monitors for prices people can afford. It’s seriously ridiculous and laughable at what the test strips cost. They should be pennies, and the companies would still make money.
11
@Mary: "In the next few years, test strips and glucose monitors will become extinct." Don't bet on it. When I became a Type 1 in 1959, at age 6, my parents and I were assured a cure was five years away.
6
Testing two hours after you begin a meal is the only way to learn diet control, and that’s what it’s all about.
25
I've had Type II for 19 years now. Lost 60 pounds, have kept it off. Initially on Metformin, now Glipizide twice daily. Used to stick my fingers regularly until I had cancer in 2007, when I stopped. Never started again. Last A1C test was 6.7, despite eating all sorts of stuff that's likely bad for me. Other health problems, coming from the cancer surgery, loom larger.
4
Dr. Carroll's article is insightful. At the same time, the JAMA study, while asking patients about hypoglycemia episodes, did not report the incidence of those episodes; it reported only severe cases. Many studies show that the prevalence of hypoglycemia is in the ballpark of 25% in people with diabetes-- perhaps even 25% within a single year-- and this condition often occurs *without symptoms*, so in many cases, it can be detected and confirmed only through monitoring. Hypoglycemia is known to cause short-term mental impairment and is also a proven risk factor for long-term cognitive impairment in the form of dementia. The Cochrane review noted that, while the number of hypoglycemic episodes did not change, they were more often reported in people doing the monitoring. Thus, we have clear evidence that monitoring is more likely to find this dangerous condition, and we now need to figure out how to lower its incidence.
--Michael Weiner, M.D., M.P.H., Professor of Medicine, Indiana University School of Medicine, Indianapolis.
26
@Michael Weiner. Sometimes we treat the patient, not the number. “Asymptomatic” hypoglycemia is certainly an interesting idea, but I don’t know that it does much harm. Has anyone shown that there is a magic number below which one is suffering damage even if they have no symptoms? Further, I’m flooded with patients who are convinced by their HBGM that they are symptomatically hypoglycemic whenever their sugar falls below 150 or even 200, and resist all attempts at better control.
2
@Gail, I find that hard to believe. Levels at 150 to 200 are are way over acceptable sugar levels unless you have just eaten. Hypoglycemic levels are about 70 or below. That would be real cause for concern. A fasting level of 150 to 200 would be of concern for different reasons,
4
You don't mention that there is no test for early-stage pancreatic cancer, but wild swings in day-to-day glucose measures may in fact be such an early warning. Diabetics are at a moderately increased risk of pancreatic cancer, the mostly deadly cancer there is. Shouldn't there be guidelines on monitoring for early signs of this disease?
9
I'm a Type 2 Diabetic who no longer home-tests daily. Twice a year A1C monitoring only.
For some of us, regular self testing may or may not be helpful but there is no denying that the marketing of test strips & meters has become a huge industry. Follow the $$$
23
I was diagnosed with Type II in 2016 (A1C >10) and self tested several times a day until I got my Type II well-controlled through diet, exercise and losing 60lbs (25% weight reduction). I was initially prescribed once daily insulin, sulfonylureas and metformin. I currently take 500mg of extended release Metformin daily and work diligently to maintain my weight at 180lbs.
I joined Planet Fitness and exercise 30 minutes on the elliptical (glucose burning marvel) almost everyday after dinner (I try to never skip more than 1 day a week)... Which ultimately does more for reducing my A1C than drugs or insulin!
Now I have my A1C tested twice a year and have been averaging ~6.0. I no longer feel the need to test daily. I figure, and my doctor agrees, as long as my A1C is under 6.5 I am good to go....
15
Diabetes Testing would be a waste of time and money - if there was no purpose in doing it. But as a former Diabetes Type 2 Coach, learning how certain foods and stress affect blood sugar is meaningful. I'm not big on Big Pharma - but I am big on investing and maintaining one's health. There's no greater gift we give to ourselves and the people who mean the most to us.
22
@Patricia
I agree! Testing for blood sugar response to foods before and after meals especially carbohydrates/starchy foods is very important in finding out which foods are culprits in controlling blood sugar over periods of time and ultimately the A1C number. In my case the culprits are white rice and potatoes and lesser so with white pasta for some reason. Also certain fruits like bananas produce blood sugar spikes. This tracking of my diet and control of certain food intake led to a 10 point drop in my A1C years ago and still helps maintain an excellent A1C reading.
4
@Patricia. Pro-testers seem to be claiming that they are exceptions to the studies. Deming pointed to a fallacy: If you measure something, it will improve. Many posters seem to use HBGM to motivate themselves, but maybe their efforts and money would be better spent just learning about diabetes, diet, and health without finger sticks.
1
@Patricia
Testing for food sensitivities took about 6 months during the first year I was diagnosed. I took the ADA classes at our local hospital, and our nurse educator made sure everyone understood how to test for food sensitivities. It's time consuming and a bit expensive since it requires a lot of strips and tests, but it was worth it. I can't eat regular rice, white or brown, without large spikes in blood sugar levels, but I can eat converted rice without a problem. Breads of any kind that contain dough conditioners cause spikes, but breads without aren't a problem. Regular pasta is a problem; whole wheat Einkorn pasta is not. I can eat berries, melons, pitted fruits, tomatoes, and avocados, for example, but citrus fruits cause spikes.
I stopped testing regularly after the second year. Now I test when on vacation (change in diet) or trying new foods. My A1C has been 6.1 for the last nine years.
Those diabetics who have trouble getting their disease under control need more help and treatment. The rest of us don't need that same level of treatment.
2
So glad that the research has vindicated my approach to addressing my Type II diabetes. For years my A1c levels remained steady at 6.2 regardless of dietary changes and a regimented of Metformin. I realized quickly that my daily blood draw added nothing new to my treatment program other than to turn testing into an unpleasant obsession. I stopped the daily ritual and just relied on my doctor’s blood draw for the A1c number, the three month blood glucose data summary.
After retiring, I have been able to significantly increase my walking regimen and focus on a more keto oriented diet. I still don’t take daily readings of my blood glucose levels. My A1c numbers have fallen to 5.7 for the first time in more years than I can remember.
21
Many people with type 2 are using continuous glucose monitors (CGMs), which show postprandial as well as premeal blood glucose levels. Thus they can see which foods make their glucose go up the most and can avoid those foods. They're seeing lower A1c's as a result.
I think the newly diagnosed should be given such meters to use for just a month or so. They could discuss the results with a medical person or a dietician to learn how to change their diets for better control.
Just giving someone a meter and test strips and telling them to test once or twice a day without instruction about what to do with the results isn't too useful.
CGMs are more expensive than test strips, but in the long run, the costs would be lower. Many patients have no idea that bread will make their blood glucose go higher than cheese because for years we have been told that fat is the problem.
57
@Gretchen You nailed it perfectly. CGMs, contrary to blood strips, give you real time information and trends, and can help you "see" which behaviors impact your blood glucose in which way, which means that CGM give you actionable information. Testing once a day is like looking at a map that's not yet been deblinded on a video game: doesn't tell you where the enemy lies until they've sent their first attack. For most people with diabetes I know, CGMs are considered as really empowering, and the clinical data shows they positively impact both A1c, hypoglycemia rate and glycemic variability in type 1 and type 2.
16
@SavMerAnyone know if CGMs are covered by Medicare?
3
Leojv,
Medicare covers the Dexcom system (currently their G5 model). A profound change in quality of life and stone cold improvement in control for me, and cheaper than strips. Go for it.
3
I am a Type 2 diabetic, on oral medications. I was diagnosed about 9 years ago, and daily (at the beginning several times a day) blood glucose testing helped me monitor the effect of the medication and of a diet I went on to lose weight, plus exercise, etc., over the first couple of years. I stopped testing for years but began again in 2016 for a while and again last year. Why? because I wasn't feeling well, and I wanted to see if the numbers showed poor control of the diabetes. This time around, the doctor has used the numbers to adjust my medication, and it's helpful to have the track of numbers showing the difference when the new dose began.
In sum, I would say that daily testing can help a newly diagnosed patient to understand the situation and modify behavior; it can also help track changes over the years. As a patient, it gives me a sense of control.
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For Type I diabetics, it is intensive blood glucose monitoring and making adjustments based on trends throughout the day that improves control. Before I had a continuous glucose monitoring system, I had to test 8-10 times a day to achieve tight control. Although there was no difference in the A1C of groups that tests once per day or not at all, it doesn't state what that A1C was--it could have been bad for both. Another study comparing a regimen of at least 5 tests per day (fasting, night, after every meal) in Type II (vs. 1 test per day) would be more useful in determining if blood glucose monitoring is valuable for Type II diabetics.
9
A question - What are the "potential harms" of home glucose monitoring for patients with Type 2 diabetes? This is mentioned in the paragraph beginning with "Choosing Wisely.
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@Mary
There is no harm but not benefit either for a type 2 diabetic (Type-1 as the article points out is a different case).
At $1-2 per test strip, testing multiple times per day (as it would be required for a type-1) is a considerable expense.
2
Dr. Carroll, M.D.: excellent info. I'm from a family of Type 2s, including Australia. Aussie M.D. was blunt about this -- "you're fat, and you don't exercise."
Trillions won't fix fat and sloth.
BTW: about Metformin .. it is OTC in Spain. Why not USA?
Also: take a look at the explosion of "sleep M.D. centers." Hey, if you're snoring/snorting -- you probably have sleep apnea. That's dangerous. Get a CPAP, plenty on eBay. Will save time, save $$$.
3
@Mary - the harm is: If you're getting high readings but your A1C is where you want it, your doctor might up your drugs based on the readings rather than the overall blood sugar control, which is the most important thing.
You can die from blood sugar too low, in a very short period of time.
You can also have myriad other bad outcomes from dangerous low blood sugar. Car crash, fall and hit your head to name just two.
6
Midway thru article it changed its tone by saying that for people not on insulin, testing is inappropriate, while earlier in article it was referring to ALL type 2 diabetics, other than those changing regimens or not well controlled. Huge difference. Maybe I need to read again, pre-coffee.
6
The campaign to label people as potential candidates for a disease has been one of the most successful marketing trends of recent years.
It relieves doctors of the need to read or learn, absolves them from healing anyone, and turns over the patient to Big Pharma.
14
My internist (here in Tokyo) has been saying this for years. I go in about once every three months, she uses a blood test to measure my HA1C level, which over the years we have watched drop from more than 12 to below 7 (through diet control and a combination of metformin and, less often, Jardience), and she'll recommend further diet improvements or other steps to keep it there. While it might be revealing to know how one's blood sugar fluctuates from meal to meal, it is not necessary to the overall treatment plan or to improving one's HA1C number (at least, not in my case).
14
My doctor(s) had told me 15 years ago to not obsess over daily testing for my Type 2 diabetes. I thought that maybe they were nuts, but my A1c had been fine for quite a few years, so I went along with them. Guess they knew what they were talking about. And it saved me some money and got rid of sore finger tips.
28
@Bob Hein- one of the minority of doctors not hooked into our de facto criminal health care system. Guard him like an ingot of gold. They are hard to find.
Don't get me wrong. Most doctors are honest but they are intermeshed with our criminal health care system.
3
I’m not diabetic, but I tested how the meals I eat most often affected my blood sugar, and it was clear to me that my numbers accurately reflected my carbohydrate intake. That affected my decisions about what to eat.
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@Peter Silverman
I am a type 2 diabetic. For maybe a year or so I have been using a continuous glucose monitor. This device has enabled me to correlate spikes in my glucose with my own behavior choices in real time and to detect falling glucose before it becomes a problem. I believe that the study, as reported can also be used to conclude that most people just don't modify their behavior based on one test per day vs no tests per day. This is interesting information but just because people do not modify behavior given information in one format does not support the conclusion that the information is not useful and actionable.
96
My thoughts exactly. How is "one test a day" (probably a fasting BG) supposed to help any one very much? The real information comes with diligent logging of foods and diligent post-prandial tests. THAT's what helps you learn to eat correctly to keep your BG in range.
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@EstherWhat this article says, Esther, is that for some people who have walked from the dining room to the kitchen 100 times, they have no reason to doubt that they can walk from the dining room to the kitchen with the same result.
2