Toby Smithson

I read a great article recently that included blood glucose testing, but parts of the article really bother me.  While the article was essentially about whether health tracking is useful with all of the new apps available for users, one angle of the article was about how unsuccessful home blood sugar monitoring has been over a 3o year period. The author called people with diabetes “early adopters” of health tracking, and pointed out that most hate it.

First, a 2001 study found only 5% of people with diabetes actually do daily testing, 65% admitting to testing less than once a month.  More concerning to me, the reason people don’t test is that they see testing as an enemy – out to remind them how poorly they’re doing. Add to this a move in some circles to stop reimbursements for testing supplies based in large part on evidence that people with diabetes don’t use testing to change behavior, and a big problem is brewing. There is a terrible disconnect within our medical system.

I know how incredibly valuable testing is….with type 1 diabetes it’s simply impossible to work things out by guessing. But, testing can be valuable for type 2 diabetes too if you use the tool to get relevant information, and to make changes. Here’s an example. My friend Mike often tests after meal just to see how a certain food has affected his blood sugar. His behavior changes aren’t major – if his blood sugar goes too high he knows that particular food doesn’t fit his metabolism well. This is how blood sugar testing can serve to improve control over time, and improved control means better health.

Contrast this to another friend who has been prescribed one test each day, first thing in the morning. Essentially, a fasting glucose 365 times a year. Guess what? Her blood sugar is virtually the same every day. There is no data upon which to make changes, and there’s no data that could possibly be any more valuable than an A1C every 3 to 6 months. This is a waste of resources and a burden on my friend, but I can’t convince her to stop because this is what her general practitioner has told her to do. She hates it, of course.

Here’s the problem. Medical policy makers in government programs and with private insurers do not provide adequate coverage for education and support time with diabetes educators.  More time with educators could result in a better understanding of testing, and less anxiety about doing it because a purpose could be defined. Some of the responsibility is with patients. But, most people want to do better with self management, and this complex condition does require active participation by those of us who stand to benefit the most – patients. I hope our members at DiabetesEveryDay will share their thoughts about testing with me. I am concerned about this marvelous tool being so misunderstood by those who could gain so much.