Summary of Physician Perspectives on SMBG in Non–Insulin-Treated Type 2 Diabetes
| Continual Proponents | Limited Proponents | Opponents | |
|---|---|---|---|
| Beliefs on recommendation of SMBG | “It allows for, first, assessment of hypo- or hyperglycemia. Two, it reinforces patient behavior as it relates to nutrition, exercise, and diet. Three, it allows for appropriate medication adjustments… Four, if there is any sudden change in their glucose, their glucose status allows for us to intervene in between office visits” (15). | “I think self-monitoring is helpful for patients who have uncontrolled blood sugars to move them in the direction of getting their blood sugars under control, with therapeutic interventions such as diet, exercise, and medications” (12). | “I will tell them, ‘Based on recent evidence, there is no indication that you have to check your sugar to control your diabetes, because we are checking the three-month blood level. I think it’s okay, and I feel safe with you not doing this as long as you’re comfortable’” (5). |
| Frequency of prescribing SMBG | “[I advise checking] twice a day, morning and evening. Some people, if they are very well controlled, I will say, ‘You know what. Why don’t you check every other day’” (5). | “I recommend that all sugars be done at fasting, first thing in the morning [initially]. After we get to a point where they are stable and we are not recommending daily sugar checks, I will recommend they check their sugars [only] if they are feeling sick…nauseous, or light-headed” (1). | “I try to steer non-insulin dependent patients away from testing at home, mainly because it doesn’t change what I do. I monitor their diabetes based on the HbA1c and occasional sugar checks” (6). |
| Beliefs on stopping SMBG | “I never recommend that they stop completely” (3). | “If they know what foods to eat… and their HbA1c is under great control, then there is really no reason for them to check their blood sugars” (17). | “I don’t tend to ever start [SMBG] in some-one who is just on orals. Many times I am inheriting patients who are already on it and used to it, so I encourage them to stop. But, they don’t necessarily want to stop” (10). |
HbA1c = hemoglobin A1c; SMBG = self-monitoring of blood glucose.