Pain? Yes. Gain? Not so much

A newly published study is renewing debate over whether it is worthwhile to ask people with Type 2 diabetes who aren’t treated with insulin to routinely test their blood sugar levels.

TORONTO — A newly published study is renewing debate over whether it is worthwhile to ask people with Type 2 diabetes who aren’t treated with insulin to routinely test their blood sugar levels.

The work, an analysis of previously published studies, showed that daily blood sugar monitoring only offers modest health benefits to people with Type 2 diabetes who aren’t on insulin. It wasn’t clear, the researchers concluded, whether self-monitoring of blood sugar levels reduced long-term complications from diabetes or lowered the risk of death from the condition.

The authors, from the Canadian Agency for Drugs and Technologies in Health in Ottawa, suggested randomized controlled trials of sufficient size and length are need to determine whether self-monitoring actually reduces the burden of diabetes complications.

Randomized controlled trials — where people are randomly assigned to receive either a drug or treatment or to receive a placebo — generate what is considered to be the highest quality scientific evidence.

The study was published Tuesday in the journal Open Medicine, which also ran a commentary suggesting the question that needs to be answered isn’t whether self-monitoring is worthwhile, but for whom it works best.

Two endocrinologists at the University of Calgary, Dr. Sonia Butalia and Dr. Doreen Rabi, suggested more targeted use of this tool would likely make more sense.

“Do all patients with Type 2 diabetes managed without insulin need to engage in self-monitoring? Probably not, but we still lack important information on how to use this technology effectively and efficiently and who will benefit the most,” Rabi and Butalia wrote.

“Ultimately we require prospective trials that examine under what conditions to make best use of this tool so that a broad, indiscriminate approach can be avoided.” Published late last year in the Canadian Medical Association Journal suggested Ontario alone could save tens of millions of dollars a year by cutting back on unnecessary glucose testing in Type 2 diabetics aged 65 and older.

That study reported that over the past 12 years, the cost to Ontario government coffers for glucose test strips rose by 250 per cent. The researchers estimated that over the next five years, the province’s tab for the test strips used by people 65 and over — those costs are picked up by the province — will be $500 million. But in 2008 alone, more than 60 per cent of strips dispensed went to people with diabetes who weren’t using insulin.