A new article in JAMA reports self-blood glucose monitoring for type 2 diabetes is not necessary.
According to the Centre for Disease Control and Prevention, CDC report 2017; 30.3 million Americans – 9.4 percent of the U.S. population had diabetes in 2015. Home blood glucose monitoring is useful to determine the daily adjustments in treatment or insulin intake. It is advised to follow doctor's recommendations about how often to test the glucose levels.
According to an article published in JAMA Intern. Med., 2018, one may not need to test themselves several times a day if it is stable type 2 diabetes and on agents (drugs) that do not cause hypoglycemia. According to this article, about 23% filled 3 or more claims for test strips during the year, 14.0% of the study population were using the supplies inappropriately; about 8.8% of subjects were taking agents, which are not considered to be a risk for causing hypoglycemia(e.g. metformin hydrochloride) and 5.1% did not have claims for any antidiabetic medications. These two groups used a median of 2.0 strips per day. The median claims cost for test strips was $325.54 per person per year. The low-value care worsens patient-centered outcomes and imparts a negative economic effect. Thus, one should avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes or on agents that do not cause hypoglycemia.
Blood glucose monitoring measures glucose levels at the time of testing. However, blood glucose levels do fluctuate according to food intake and physical activity. Currently, to monitor diabetes, glycated hemoglobin (HbA1c) is considered as a standard which assesses long-term average blood glucose for a period of last three to four months. It is reported that HbA1c is not effective in clinical situations which may interfere with the metabolism of hemoglobin, such as in hemolytic or iron deficiency anemia, hemoglobinopathies, iron related complications in pregnancy, and uremia.
As an alternative to blood glucose testing, a short 30 day monitoring of glycated albumin should be examined. Albumin is the largest circulating protein in the blood. Glycated albumin refers to albumin attached to glucose and offers an advantage of monitoring average blood glucose over a short-term period of one month (as albumin replaces itself every 30-days). A rapid test for GA could be a significant benefit for patients to control diabetes and other related complications on a monthly basis. Epinex has patented a rapid test for Glycated Albumin (G1A) and is developing this test for clinical trials. G1A tests measures total albumin and glycated albumin exclusively, in a handheld device as a POCT (Point of Care Test) for doctors’ offices and clinics, and as an OTC (Over The Counter) test for general public use.
Reference: Kevin D. Platt, Amy N. Thompson, Paul Lin, MS., et al. Assessment of self-monitoring of blood glucose in individuals with Type 2 diabetes not using insulin. JAMA Intern Med. 2018. doi:10.1001/jamainternmed.2018.5700
Bhairavi Vajaria, Ph.D.
Research and Development Associate
Epinex Diagnostics, Inc.