For type 2 diabetics who are not on insulin, monitoring their blood sugar does little to control blood sugar levels over time and may not be worth the effort or expense, according to a new evidence review.

Self-monitoring blood sugar levels for type 1 diabetics and type 2 diabetics who require insulin is recognized as a critical part of self-care.

For these insulin taking diabetics, keeping track of blood sugar levels helps them attempt to keep glucose levels within an acceptable range.

However, it has been unclear if self-monitoring of blood sugar has the same value for type 2 diabetics who are not on insulin.

To answer this question, Uriëll L. Malanda of the VU University Medical Center in Amsterdam and his colleagues reviewed 12 studies, of more than 3,000 non-insulin-using diabetics.

The review showed that self-monitoring of blood sugar by these patients had only a modest effect on a measure called HbA1c, a standard for assessing blood glucose control.

Over a six-month period, patients who tested their own blood glucose levels reduced HbA1c by about 0.3 percent. This effect nearly completely dissipated after 12 months.

Key Points:

• In patients with diabetes who don’t require insulin, self-monitoring of blood glucose had a modest effect on HbA1c levels at six-months, which subsided after 12 months.

• Self-monitoring of blood glucose in non-insulin treated diabetics had no effect on satisfaction, general well-being or general health-related quality of life.

• Supplies required for self-monitoring of blood glucose are more expensive than for urine testing, a common alternative for non-insulin treated diabetics.

Additionally, the review showed that blood sugar self-monitoring had no effect on patients’ satisfaction, general well being, or general health-related quality of life.

One study, which compared the cost of the first year of monitoring blood for glucose versus urine testing, found that monitoring blood glucose was 12 times more expensive.

Mayer Davidson, M.D., a professor of medicine at Charles Drew University in Los Angeles who authored one of the studies included in the review, notes that many endocrinologists recommend blood glucose self-monitoring as part of efforts to educate patients on the effect of lifestyle habits—for example, how eating an apple affects their blood glucose compared to drinking a glass of apple juice. However, knowing their blood sugar numbers doesn’t appear to change patients’ behavior.

“Patients aren’t using these numbers to do anything clinically significant,” he says.

With the cost of blood glucose test strips for home monitoring equipment hovering around 1 dollar apiece, he adds, there doesn’t appear to be enough “bang for the buck” to recommend that form of self-monitoring for most patients.

Authors of the review agree. “Regular self-monitoring of blood glucose in non-insulin treated patients has minimal impact on glycemic control, has no impact on general well-being or quality of life, and is rather expensive. Consequently, it does not add to a clinically relevant long-term benefit,” Malanda says.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

By Jenny Gold
This story was produced in collaboration with 

On a Monday night in December, Lauretta Martin, 47, visited the sleep lab at the National Rehabilitation Hospital in Washington, D.C. for the second time.

On her first visit, Martin, a heavyset woman whose husband reports she is a loud snorer, was diagnosed with sleep apnea. This time, she was being fitted for a CPAP machine, which helps keep a snorer’s airway open throughout the night.

The sleep lab has six testing rooms, each of which looks just like a room at a Holiday Inn, with striped wallpaper, a floral bedspread, framed prints of the seaside and free wifi.

“They have a brochure that says it’s just like being in a hotel room, and it is,” says Martin, sitting on the edge of her bed wearing a pair of soft grey pajamas and watching a football game on her flat-screen TV.

Aside from the two-dozen colorful electrodes taped to her body to monitor her every motion and the scuba-style mask on her face to enhance her breathing, she looked ready for a cozy night of slumber.

In the tech room a few doors down, a professional sleep technician observed her over a video monitor, testing the electrodes and preparing to listen in to the sounds of her sleep.

Snoring was once considered a simple annoyance for bed partners, but there is a growing awareness in the medical community that the grunts and snorts of noisy sleepers can also be a sign of sleep apnea, a condition shown to increase the risk of numerous serious illnesses, including heart disease, stroke and dementia.

Testing can be a lucrative business, and labs have popped up in free-standing clinics and hospitals across the country. Over the past decade, the number of accredited sleep labs that test for the disorder has quadrupled, according to the American Academy of Sleep Medicine (AASM).

Sleep apnea occurs when the muscles in the back of the throat relax, causing an airway obstruction that can stop a person’s breathing for several seconds or even minutes.  It causes restless sleep and sometimes dangerously-low blood oxygen levels.

The disorder can be diagnosed by monitoring a snorer’s sleep patterns, either in an overnight visit to a sleep lab or at home using a portable testing device. It is then often treated with a CPAP machine, which helps keep a snorer’s airway open during sleep.

Sleep apnea has likely gotten more common as the population has grown older and more obese, two major risk factors for apnea, and the National Institutes of Health estimates that more than 12 million Americans suffer from the disorder.  Many are never diagnosed.

“I think the medical community is sort of dropping the ball” on apnea, explains Dr. David Gross, medical director of the sleep lab at the National Rehabilitation Hospital. “It’s just sad when you walk through the hospital and you see these patients with heart failure—the person might be 35 years old, he’s 350 lbs — but no one’s thinking that he has sleep apnea, which he statistically does.”

Dr. David Gross, director of the sleep lab at the National Rehabilitation Hospital in Washington, D.C., analyzes a sleep test (Photo by Jenny Gold/KHN)

He says more than three-quarters of the patients who come to the lab are diagnosed with apnea.

But the testing isn’t cheap: each night at a hospital sleep lab can cost $1,900 and is usually mostly covered by a patient’s health insurance. Some patients, including Martin, end up spending two nights at the lab – one to test for apnea, and the second to try the CPAP machine.

Dr. Fred Holt, an expert on fraud and abuse and the medical director of Blue Cross Blue Shield in North Carolina, says some patients aren’t having basic exams done first and are therefore being prescribed expensive tests they don’t need. Not everyone who snores has a chronic disorder, he notes.

In other cases, Holt says the labs prescribe CPAP machines right away without first suggesting other strategies like losing weight of sleeping on your side, which can also reduce apnea.

“We are spending more and more money on sleep testing and treatment, and like anything else in health care, there are unscrupulous people out there who are more than happy to do testing and treatment that might be of questionable value,” says Holt. “This might be because of naiveté on the part of the physician, or unfortunately, it could be done for the sake of improving the cash flow of one’s business.”

It’s no secret that the sleep business can be lucrative for physicians. A website for Aviisha, a sleep testing company, has a section for physicians showing a picture of a doctor with a stack of money in his lab coat pocket.  And in February, the AASM is offering a seminar on the “business of sleep medicine for physicians” at a golf resort in Arizona.

Dr. Nancy Collop, president of the AASM, says that while many sleep centers offer comprehensive care for sleep disorders, others are largely focused on overnight sleep testing.

“A lot of people have gotten into the sleep business specifically to do that procedure,” she explains. The goal of the AASM’s accreditation process, she says, is to make sure sleep labs are offering more because “many patients may not even need a sleep study.”

Helen Darling, president of the National Business Group on Health, which represents large employers offering health insurance to their workers, says the tests are driving up the cost of premiums.

“This is a good example of something where we have technology, we have financial incentives to use more of it then we have historically done, you have enough problems including a growing obesity epidemic, and you sort of put together the so-called perfect storm for driving up overuse and health care cost,” Darling says.

She says doctors should focus instead on common-sense approaches to sleep apnea, like losing weight, before turning to expensive testing and medical devices.

Another option are home sleep tests, which costs less than a fifth of the cost of a lab test, and are considered effective for most patients. Medicare began paying for home sleep tests in 2008, but the tests have had only modest growth.

“I believe lab tests, as opposed to the home tests, are being wildly overprescribed,” says Mike Backus, senior vice president of American Imaging Management, a subsidiary of Wellpoint.

Right now, he says, 99 percent of the sleep tests given to Wellpoint patients are done in the lab, but “it should be 70 percent at home and 30 percent in the lab.”

Backus adds that the majority of patients who are diagnosed with apnea and then given CPAP machines stop using them within the first year.

Some insurers, including Wellpoint, are changing the way they pay for sleep testing to curb the costs. Many now require a special pre-authorization. They also ask the doctor whether a patient qualifies for a home sleep test instead of one at the lab.

Those changes are now widespread among Massachusetts insurers and are having an effect on the sleep industry in the state.

Dr. Lawrence Epstein, the chief medical officer of Sleep Healthcenters in Massachusetts, says the labs have already experienced a 20 percent drop in the number of patients coming in for testing.

While the past decade was focused on industry growth, he says it’s “now going to be about consolidation and provision of better quality, more efficient care.”

Sleep Healthcenters has shut down three of its 15 sleep labs, and more closures may be on the way. Epstein says the company is focusing more on “sleep wellness,” including treating and managing sleep disorders, and less on testing.

The key, he explains, is to become more efficient without decreasing access to care for patients who need it.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The New York Times Magazine: The Fat Trap

For years, the advice to the overweight and obese has been that we simply need to eat less and exercise more.

While there is truth to this guidance, it fails to take into account that the human body continues to fight against weight loss long after dieting has stopped. … it’s clear, from a public-health standpoint, that resources would best be focused on preventing weight gain.

The research underscores the urgency of national efforts to get children to exercise and eat healthful foods. But with a third of the U.S. adult population classified as obese, nobody is saying people who already are very overweight should give up on weight loss. … Studies suggest that even a 5 percent weight loss can lower a person’s risk for diabetes, heart disease and other health problems associated with obesity (Tara Parker-Pope, 12/28).

National Review: Santorum’s Pro-Life Credibility

Santorum truly is an excellent representative of his cause. Perhaps no politician in our national life has been so pointedly forced by circumstances to live up to his creed. If Santorum can seem too blithe and self-assured when he talks the talk, he has painfully walked the walk. The Santorums lost one child shortly after childbirth and have another who survived despite a grave, usually fatal, genetic disorder (Rich Lowry, 1/4).

Salon: Rick Santorum Is Coming For Your Birth Control

Here is an actual Rick Santorum quote: “One of the things I will talk about, that no president has talked about before, is I think the dangers of contraception in this country.”

And also, “Many of the Christian faith have said, well, that’s okay, contraception is okay. It’s not okay. It’s a license to do things in a sexual realm that is counter to how things are supposed to be.”

… while reproductive rights are always cast in terms of pro or against a woman’s right to an abortion and in what circumstances, even liberals are surprised to find out what social conservatives really want to do about contraception (Irin Carmon, 1/4).

American Medical News: Health Reform After 2014: Not-So-Universal Coverage

The national health system reform law is expected to reduce the nation’s uninsured population to what could be an all-time low. But even after the major reforms take effect starting in 2014, millions will remain without coverage, whether by choice or by circumstance. … each region of the U.S. is expected to see its uninsured population shrink by roughly half  …  he health reform law’s true impact on the final tally and demographics of the uninsured will be shaped by the decisions of consumers, employers, federal health officials and states (Doug Trapp, 1/2).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Chef Eric has struggled to manage his weight his entire life, and blogs on the Swedish website about food, his weight loss journey, eating in public, and more.

Dr. Richard Lindquist, a specialist with Swedish’s Weight Loss Services, provides some holiday eating tips to help you avoid those extra calories.

Spiced Hot Toddy

Serves 6 — 5oz drinks

Ingredients:

• 1 quart Light Soy milk
• 1 vanilla bean — split with seed scraped out
• 2 cinnamon sticks
• 1 TBSP honey
• 1 whole Nutmeg

Preparation:

1. Place soy milk w/vanilla bean and cinnamon sticks in sauce pan, bring just to simmer, insuring not to boil. Remove from heat. Add honey.
2. Allow the spices to steep for 10 minutes.
3. Transfer all the ingredients to a French press and press all spices down to the bottom.
4. Froth the toddy by carefully pumping up and down on the press, divide among 6 tea cups
5. Grate fresh Nutmeg over the Toddy, serve immediately.

Nutritional Information:

• 100 calories
• 1.5 grams of fat
• 6 grams of protein
• 12 grams carbs

Green Tea & Rosemary Sparkler

Makes 1 — 12 oz serving

Ingredients:

• 1 bag – Favorite Green Tea
• 2 inch stalk of Lemongrass (can substitute a lemon wedge)
• 1 stem of rosemary — small sprig removed from the top reserved
• 4 oz hot water
• 8 oz favorite sparkling water
• Ice cubes (optional)
• Artificial sweetener (optional)

 Preparation:

1. Steep the tea bag in the 4 oz of hot water with the lemongrass and the rosemary. Remove the teabag after 3 minutes let the herbs remain until the water reaches room temperature.
2. Strain tea into a tall glass over ice and sweetener (optional)
3. Add the 8 oz of bubbly water and a sprig of rosemary for garnish

Nutritional Information:

• 0 calories