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    Friday, July 20, 2007

    Questioning the Intuitive: We assume that having diabetics check their blood sugar regularly at home with a glucometer will improve compliance with diet and thus improve blood sugar control. It makes sense on an intuitive level, but that intuition may be wrong:

    In the study, Farmer's team randomly assigned 453 patients with type 2 diabetes to one of three groups.

    One group had their blood sugar level checked three times a month. The second group was given a meter to test their blood sugar at home and told to have their doctor interpret the results. The third group was given meters and taught how to interpret the findings.

    At one year, Farmer's group found no difference in blood sugar levels between the groups. In addition, there was no evidence that having patients monitor their blood sugar improved their glucose control.

    Moreover, half of the people who had been given glucose monitors stopped using them before the end of the study, Farmer said.

    Although that link is to a story generated by a diabetes conference, the full paper is online here. As you can see from this graph, checking blood sugars daily didn't make much of a change in the HbA1c, our standard measure of control.

    This is certainly something to chew over. Glucometers are expensive. And, although the machines themselves are often given away in promotional stunts, the strips they use to measure the blood sugar are also quite expensive. Medicare spends millions a year on this alone. (Which is why doctors now have to specify on a prescription for the test strips how often their patients test their blood sugar and why if it's more than once a day.) But it's hard to give up our intuitive ways, isn't it?

    posted by Sydney on 7/20/2007 06:26:00 PM 2 comments


    This was first reported a short time ago in the popular press. My concern then, as now, is the drive to make people diabetics in order to change codlings, increase office visits, and sell product. We have seen the drug industry, and device manufactures, increasingly involved in lowering long held standards in any number of areas.

    BP is now always suppose to be under 120/80. LDL under 100. Blood sugar under 105. No exceptions. All this is suppose to be done using a no fat, high carb and starch diet, which for some, myself included, spikes our blood sugar into the 120's.

    Many of my older friends are scared to death of their blood sugar readings. They try to stay on impossible diets. Add these now other areas of concern into lifestyle choices and they have become chained to medications and doctors appointments. All the while the drug manufactories and device makers take in ever increasing profits.

    I have no objection to medications and have seen how certain devices enhance a persons life. My problem is the public has been lead headlong into a sense of perpetual illness that can only be solved by massive medication. Doctors are goaded into prescribing by drug reps who raise the specter of community standards and possible law suits.

    All I am asking for is a little common sense in this, and other areas of health measurement.

    Steve Lucas

    By Anonymous Anonymous, at 8:17 AM  

    I note that the number of tests used in the trial was 6 per week. Useless.

    I, a T2, use 20 to 30 tests or more per week to follow these ideas...


    My HbA1c went from 8.3 to 5.4.

    I think the design of the study/instructions to the participants is the problem.

    Wrong instructions, poor result.

    By Anonymous Anonymous, at 11:01 PM  

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