Comments on: Study: Diabetes self-monitoring not cost effective

By: Morris Older

Morris Older — Mon, 04 Jan 2010 19:21:01 +0000

There have been similar studies–in Australia and elsewhere–with the same conclusion, and all with the same flaw. If people are taught how to test strategically, and how to use the outcome of those tests to make changes to their diet and their exercise regime, testing can make a huge difference in A1c and all other measures of blood sugar management. In fact at first, when some one is learning about the implications of their choices, testing 6 or 8x/day for a few weeks or months can be very instructive for people with Type 2 Diabetes.

But simply testing, without adequate instruction on when to test and how to use the results, cannot improve outcomes by itself, so these studies are just stating the obvious. In essence they are designed to see what doesn’t work, rather than to find out what will work.

Testing by itself has little impact. Testing with education added has a huge impact.

By: David Doherty

David Doherty — Tue, 29 Dec 2009 15:30:43 +0000

@Kevin: Great to have such an authority as you on this area stepping in here to point out the very obvious flaw in this research. Agree 100%

By: Kevin

Kevin — Thu, 24 Dec 2009 17:26:17 +0000

This research is flawed in that it asks a question about whether or not increased test frequency correlates directly to significantly improved outcomes. Everyone should agree that the answer to this is a resounding No. Just seeing a number on a meter does not translate into the actions a patient must take to improve blood sugar control. Just making the meter wireless doesn’t solve the data — action gap either. The right question to ask is whether or not a person (not just those diagnosed with diabetes either), using test strips to check strategically to understand cause and effect has improved outcomes vs. a person in any number of various other methods/study arms (ie – 1x per day checker, 2x per week random checker, 3x per day random checker, etc…)

The research that I have been involved in (I am a CEO of a wireless health company) on several behavioral studies shows without a doubt that checking strategically with a daily average of 1.5 checks per day results in a clinically significant reduction in A1c vs a control group of ‘Free-Range’ patients doing their own thing.

If you go to Pubmed.gov and read up on all of this research, regardless of which side it’s on, you will see a disturbing pattern in their conclusions…”looks promising… needs further research”. It’s way past time we design studies that can deliver the definitive answers to these questions surrounding diabetes – a health condition managed by patient behavior whether it’s type 1 or type 2 – once and for all.

Or would that dry up a seemingly unlimited flow of cash into the pockets of academic researchers and their institutions?

By: Joseph Kvedar

Joseph Kvedar — Thu, 24 Dec 2009 12:48:32 +0000

This is not a surprising result. If one could divide the sample into segments: those with high a1c, those who feel accountable to their health outcomes, the cost-effectiveness would emerge.

By: Merrilee Fullerton

Merrilee Fullerton — Wed, 23 Dec 2009 15:31:38 +0000

the title is misleading….the frequency of testing is what is being evaluated…not self-monitoring itself.