We recently wrote about a study which concluded that blood glucose meters are a waste of time for people with type 2 diabetes who are not using insulin ("Is Using a Meter a Waste of Time for Type 2s?"). Our readers vehemently disagreed with that conclusion.

Now a lengthy study in the British Medical Journal has delved into the reasons why meters are often not used effectively by people with type 2. And it has concluded that the problem lies, first, in caregivers' failure to educate type 2s about how to respond to blood sugar readings, and, second, in an apparent disinterest in meter readings on the part of healthcare professionals.

The British study involved eighteen Scottish patients newly diagnosed with type 2 diabetes who were not taking insulin. They were interviewed three times in the first year and then once again three years later. By the end of the study, many had stopped self-monitoring altogether, and the remainder were doing so less frequently.

None of the patients had received explicit messages from their healthcare providers about when, how, and why they should be testing their blood sugar. Most of the patients believed that they were testing for the benefit of their caregivers only, not for their own information. And many of their doctors didn't encourage meter use. As one patient said, "At first Dr. M thought that the meter thing might be a bit fiddly for me."

When the caregivers didn't seem to care, the patients lost interest in testing. They began to feel that self-monitoring was "pointless" because "nobody ever looks at it." Said one, "I did gather the impression that they didn't really bother too much with the day to day results…and it seemed to me that it maybe wasn't worth keeping an eye on all of this."

Most subjects felt that their doctors were interested only in their A1c's, not in their meter readings. One said, "They would be more concerned about the three monthly reading…and that didn't take account of my concerns, which were the big spikes I was getting."

The subjects were generally reassured by lower readings and understood that by eating they could raise their blood sugar. However, they had no idea how to make use of high readings, which either bamboozled them completely or made them anxious. Said one about high readings, "What do you do when it's high? [The diabetes nurse] never explained that." Said another, "What if it goes high? What do you do to bring it down?"

Instead of using their blood glucose readings to understand their responses to food and activity and to guide long-term change, many participants interpreted their readings only as a reflection of short-term "good or bad" behavior. Said one person, "It's telling me if I'm being bad…and I think, 'uh oh, I ain't using you [the meter] today.'" They worried about how much they had just eaten, but didn't consider other aspects of management, such as changing their overall diet, medication, or exercise regimen. Many of them were convinced that they could accurately guess their blood levels without using a meter.

In light of these findings, the researchers recommend that education about monitoring should be ongoing, with particular emphasis on how to respond to high readings. The relation between individual readings and patterns should be clarified, as well as the relationship between individual readings and A1c's. Without such education and interest on the part of healthcare professionals, people with type 2 are often left in the dark when it comes to their meters.

Source: British Medical Journal, August 2007