JAMA study: technology to self-monitor blood glucose levels no better than traditional management of type 2 diabetes

By Heather Mack
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Diabetes management is among the most active, well-funded and rapidly-evolving areas of digital health. Connected tools that allow people living with diabetes to monitor their own blood glucose levels and work with digital coaching platforms to choose the best lifestyle practices to stay healthy abound, as do analytics platforms that enable remote monitoring and more detail-rich data visualization to help clinicians keep better tabs on their patients.

But compared with the traditional method of in-office visits, does self-monitoring of blood glucose (SMBG) via digital tools result in better health and wellness for people with non-insulin-treated type 2 diabetes?

In the case of a 450-person cohort studied at 15 primary care practices across the University of North Carolina Chapel Hill health system, the answer was a flat “No.”

The patients were randomized into three different groups. Two groups were given the Telcare connected blood glucose monitor, with one of those groups simply checking in with the device and the other doing the same plus receiving “enhanced patient feedback” (in the form of automated, one-way messages delivered directly on the meter). The third group did not receive a device. After the patients were randomized into groups, their primary care clinicians worked with them to manage their conditions, with those whose patients were using the Telcare devices receiving a summary of the data via their electronic health records.

Researchers were measuring outcomes based on hemoglobin A1c levels and health-related quality of life. Over a year’s time, there were no significant differences in hemoglobin A1c levels nor health-related quality of life over all three groups.

“Incorporating technology into self-management activities has been touted as potentially transformative for patients, and to date some smaller studies support this notion. However, our findings do not,” the researchers wrote in an article published by the Journal of the American Medical Association.

Telcare is hardly the only blood glucose meter out there, but it’s notable for being the first cellular-connected device of its kind to receive FDA clearance, which it got in 2011. Though well-regarded and enticing enough to elicit an acquisition by BioTelemtry in December 2016, the device is not particularly advanced in regards to patient interaction compared with those with companion smartphone apps or sophisticated digital coaching tools.

That being said, the researchers did point to a small difference between those in the enhanced SMBG group – those receiving the messaging algorithm that accounts for blood glucose value, time of day and relationship to food intake – and those who simply used the device to check their levels once per day.

“Studies of enhanced SMBG, where patients and/or clinicians were educated to better interpret SMBG values, found hemoglobin A1c reductions close to 0.5 percent, compared with simple SMBG, where levels were reduced by 0.2 percent, an amount that was statistically significant but of doubtful clinical significance,” the authors wrote. “This pattern suggests that, for SMBG to be an effective self-management tool in non–insulin-treated T2DM, the patient and physician must actively engage in performing, interpreting, and acting on the SMBG values.”

It’s an interesting point to consider when reviewing the study. Text messaging as a means to patient engagement has been studied in various populations, including Medicaid populations, and data suggests interactive, two-way messaging is much more successful in engaging patients that automated texts.

While the researchers were not wowed by the use of digital diabetes management devices, they aren’t writing them off altogether.

“Although disease duration, experience using SMBG, baseline glycemic control, antihyperglycemic treatment, age, race, health literacy, and number of comorbidities made no discernable difference in glycemic control at 52 weeks, absence of evidence is not evidence of absence,” they wrote.