Choosing Wisely:

Don’t routinely recommend daily home glucose monitoring for patients who have type 2 diabetes mellitus and are not using insulin.

Rationale and Comments: Self-monitoring of blood glucose is an integral part of patient self-management in maintaining safe and target-driven glucose control in type 1 diabetes mellitus. However, daily finger glucose testing has no benefit in patients with type 2 diabetes mellitus who are not on insulin or medications associated with hypoglycemia, and small, but significant, patient harms are associated with daily glucose testing. Self-monitoring of blood glucose should be reserved for patients during the titration of their medication doses or during periods of changes in patients’ diet and exercise routines.
Sponsoring Organizations:
  • American Academy of Family Physicians
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Endocrinologic
  • References: • JAMA: More Evidence That Glucose Self-Monitoring May Not Improve Outcomes in Non-Insulin Dependent Type 2 Diabetes http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2630691.
    • Society for Internal Medicine Choosing Wisely Recommendation: Don’t recommend daily home finger glucose testing in patients with Type 2 diabetes mellitus not using insulin. http://www.choosingwisely.org/clinician-lists/society-general-internal-medicine-daily-home-finger-glucose-testing-type-2-diabetes-mellitus/.
    • American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2013;36 Suppl 1:S11-66.
    • Karter AJ, Parker MM, Moffet HH, Spence MM, Chan J, Ettner SL, Selby JV. Longitudinal study of new and prevalent use of self-monitoring of blood glucose. Diabetes Care. 2006;29:1757-63.
    • Harris MI. Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Diabetes Care. 2001;24:979-82.
    • Malanda UL, Welschen LMC, Riphagen II, Dekker JM, Nijpels G, Bot SDM. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database of Systematic Reviews 2012;1:1-88.
    • O’Kane MJ, Bunting B, Copeland M, Coates VE; ESMON study group. Efficacy of self-monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomized controlled trial. BMJ. 2008;336:1174-7.
    • Peel E, Douglas M, Lawton J. Self-monitoring of blood glucose in type2 diabetes: longitudinal qualitative study of patients’ perspectives. BMJ. 2007;335:493-8.
    • Cameron C, Coyle D, Ur E, Klarenback S. Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin. CMAJ. 2010;182(1):28-34.
    • Canada’s Choosing Wisely Recommendation: Don’t recommend routine or multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia. https://choosingwiselycanada.org/endocrinology-and-metabolism.
    • Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, et al. Monitoring glycemic control. Can J Diabetes. 2013;37 Suppl 1:S35-9.
    • Davidson MB, et al. The effect of self monitoring of blood glucose concentrations on glycated hemoglobin levels in diabetic patients not taking insulin: a blinded, randomized trial. Am J Med. 2005;118(4):422-5.
    • Farmer A, et al. Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial. BMJ. 2007;335(7611):132.
    • O’Kane MJ, et al. Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial. BMJ. 2008;336(7654):1174-7.

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