The Canadian Agency for Drugs and Technologies in Health (CADTH) has synthesized existing data on the clinical and cost-effectiveness of self-monitoring of blood glucose (SMBG) in type 2 diabetes to help physicians make better-informed decisions about the optimal use of blood glucose test strips.

1. Self-monitoring of blood glucose (SMBG), a vital self-management tool in type 1 diabetes, has become a widespread practice in the management of patients with type 2 diabetes not using insulin, yet its use for this indication has not been supported by evidence.

2. In patients with type 2 diabetes who don’t use insulin and test more than 7 times a week, the cost-utility of SMBG is very low. Over 40 years, 36.2% of those in the group who self-monitored would suffer a serious diabetes complication, compared to 36.5% of those who did not.

3. Adults with type 2 diabetes who aren’t using insulin don’t need to test routinely. Testing less will save patients time, pain and inconvenience; and it won’t negatively affect their health.

4. Periodic or short-term testing may be helpful for patients with type 2 diabetes who aren’t using insulin in the following circumstances: unstable glucose levels, acute illness, recent changes to medication schedule or other routine, use of medication that carries a higher risk of hypoglycemia (e.g. sulfonylureas).

5. Evidence is insufficient to make a recommendation on SMBG in the following groups: women who are pregnant or trying to become pregnant, children, First Nations, people with a history of hypoglycemia and those with occupational risks from hypoglycemia, such as truckers and pilots.

6. All patients with type 2 diabetes who take insulin, as well as women with gestational diabetes, should self-monitor and the frequency should be tailored to their clinical condition.

7. Patients should be informed that there’s more to self-management of type 2 diabetes than SMBG. Exercise, a healthy diet, foot inspection, vision care, taking medication as directed and regular doctor visits are all important self-management techniques.

8. Recommendations have been made in England, Scotland, Sweden, Germany and the U.S. to place limits on reimbursement for blood glucose test strips. The Canadian Diabetes Association recently
released a position statement recognizing that limitations on government reimbursement for blood glucose test strips may be reasonable in patients not taking insulin.

9. Total Canadian spending on blood glucose test strips exceeded $500 million in 2010. If practice changes to reflect the evidence, about $200 million per year could be freed up to spend on other proven strategies.

10. SMBG is only as useful as the action it triggers, and there are few available immediate actions for patients with type 2 diabetes not taking insulin. Tests should only be done when results are linked to treatment decisions or specific patient actions, such as taking glucose or altering insulin dose.

Providing evidence-based information to guide health decisions and improve health outcomes.
For more information and tools on self-monitoring of blood glucose go to

www.cadth.ca/en/products/optimal-use/self-monitoring