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 Michelle Andrews

Jackie Risley, before and after her bariatric surgery (Photos provided by Risley)

As obesity among young people continues to rise, a growing number of clinicians and researchers say that weight-loss surgery may be their best chance to take off significant weight and either correct or avoid conditions like diabetes and heart disease, which often go hand-in-hand with obesity.

But although health plans frequently cover bariatric surgery in adults, insurance coverage for the procedure in patients under age 18 is spotty.

Experts in pediatric obesity say that caution is warranted and that insurers shouldn’t just rubber-stamp such surgery in adolescents.

But they say emerging research may lead to more coverage for young people.

Photo by Sue_r_b

America seems to be detrimental to the health of Hispanic immigrant populations — and the longer they are here the worse it is.

New data show that as they settle into American lifestyles, Hispanic immigrants are diagnosed with hypertension, diabetes and obesity at almost the same rate as those born in the U.S.

Hispanic immigrants who have been in the U.S. for 20 years or more are 98 percent more likely to become obese, 68 percent more likely to develop hypertension and about two and a half times more likely to become diabetic than those who have been in the U.S. for less than a decade.

Leslie Cofie, a first-year doctoral student at the University of North Carolina, and the lead researcher on this study, used data from the Centers for Disease Control and Prevention’sNational Health and Nutrition Examination Survey — a group of national studies that combines interviews and physical exams to get the numbers on health outcomes.

“A lot of the studies that have been done before on immigrants have been based on self-reported data sources,” Cofie said. But, he says, self-reported data is more error-prone since it is relying on a person’s recollection. The NHANES studies, however, provide a more comprehensive look since they use medical examination records collected by trained professionals.

At the annual American Public Health Association meeting Cofie discussed findings about Hispanic immigrants who have been in the U.S. up to 20 years and said those who were in the U.S. longer had a significantly higher percentage of hypertension, diabetes and obesity than the Hispanic immigrants who have been here for 10 or fewer years.

Female Hispanic immigrants who have lived in the U.S. for 20 or more years are more prone to obesity and hypertension, while the male Hispanic immigrants living in the U.S. for 20 or more years are more prone to diabetes.

Cofie said that his analysis shows that variables such as access to health care, social economic status or even documentation have no real effect on the number of Hispanic immigrants diagnosed with these chronic conditions. “Even after we control for all those factors, we still see higher prevalence in poor health outcomes of these immigrants.”

Dr. Emilio Carrillo, the vice president of Community Health Development at New York-Presbyterian Hospital said this data is an unfortunate, but inherent part of the Hispanic immigrant experience in the U.S.

“It’s well known that the first generation that came here had a healthier experience,” he said. “But then the next generation comes along and they tend to adapt to the American lifestyle …” which includes poor eating and exercise habits.

Jennifer Ng’andu, the deputy director of the Health Policy Project at the National Council of La Raza in Washington said Hispanic immigrants “are severely disconnected from the health care system.” Ng’andu adds that the more Hispanic immigrants are detached from the health care system, the more costly it will be to support their health care needs. “It’s going to cost us more to keep immigrants outside of the health care system.”

Photo by Sue_r_b

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.

Lifestyle changes that include dieting to lose weight and exercise can help prevent type 2 diabetes, but researchers were uncertain which element contributes more.

A new study suggests that, in postmenopausal women at least, dietary weight loss alone is effective while exercise alone is not effective, and both together are best of all.

“The effects seems to be additive,” said Caitlin Mason, Ph.D., lead study author. “The women who did both diet and exercise together had the greatest weight loss and greatest improvement in insulin and blood sugar control.”

In light of the additional benefits of exercise, such as preserving muscle mass during weight loss, “a combined program is the way to go,” said Mason, a postdoctoral fellow in public health sciences at the Fred Hutchinson Cancer Research Center.

Key Points

• A combination of dieting and exercise is most effective in reducing type 2 diabetes risk in postmenopausal women, a new study finds.

• Dieting alone is more effective than exercise alone in promoting weight loss and reducing the risk of type 2 diabetes.

• Women at risk for diabetes can lose weight and achieve healthier insulin resistance and fasting glucose measures by improving their diet and exercise habits.

Receiving advice about diet and exercise in small groups can reduce women’s risk of developing type 2 diabetes and is more practical than individual counseling from a public health standpoint.

For the study, which appears online and in the October issue of the American Journal of Preventive Medicine, 439 inactive, overweight postmenopausal women were randomly assigned to participate in a dietary weight loss program, an aerobic exercise program, or a program that included diet and exercise, or were told not to change their eating or exercise patterns.

Participants received diet and exercise counseling in groups of eight to 15 women, rather than individually.

The researchers estimated the women’s insulin resistance – which reflects how well or poorly the body metabolizes sugar – and their fasting blood sugar, when the study began and after 12 months. Increased insulin resistance and elevated blood sugar are signs that the risk of diabetes is high.

Insulin resistance improved significantly with diet and a bit more in the diet-plus-exercise group, but not with exercise alone, compared to women who made no changes. Exercise alone did improve fasting glucose, but only when it was elevated to begin with.

Women in the diet group lost an average of 8.5 percent of their initial body weight, while those who had diet plus exercise lost more than 10 percent. Improvement in insulin resistance was proportional to the amount of weight lost.

Jill Crandall, M.D., director of the Diabetes Clinical Trials Unit at the Albert Einstein College of Medicine, said she was “most impressed” by the magnitude of weight loss achieved in the study, “but the effect this will have on glucose metabolism or diabetes risk in the long run is a little hard to say from this paper.”

One of the most useful things the study did was to show that “a group-based program could be very effective for weight loss,” added Crandall, who has no affiliation with the study. From a public health perspective, she said, “anything done in the group setting is more feasible.”

She noted that strengthening exercise appears to have greater benefits for insulin resistance than aerobic exercise, and suggested that its inclusion in future studies might be “a desirable feature.”

The report, F as in Fat: How Obesity Threatens America’s Future 2011, prepared by Trust for America’s Health and the Robert Wood Johnson Foundation, found that obesity rates continue to rise nationally, with obesity rates now exceeding 25 percent in more than two-thirds of states (38 states).

Twelve states now have obesity rates above 30 percent, the report found: Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia.

Four years ago, only one state was above 30 percent.

Mississippi had the highest rate of obesity at 34.4 percent.

Colorado had the lowest rate at 19.8 percent and is the only state with a rate below 20 percent.

Adults with a Body Mass Index (BMI) of 25 to 29.9 are considered overweight, while those with a BMI of 30 or more are considered obese. Use the BMI calculator widget on the right to determine your BMI.

Obesity rates among the young is also on the rise: Today, more than one-third of children ages 10–17 are obese (16.4 percent) or overweight (18.2 percent).

Oregon had the lowest child obesity rate, 9.6 percent; Mississippi had the highest at 21.9 percent.

Washington state ranked 48th in the nation for child obesity at 11.1 percent.

“It’s not just our health that is suffering: obesity-related medical costs and a less productive workforce are hampering America’s ability to compete in the global economy,” the report warns.

The report proposes six strategies for combating the nation’s obesity epidemic:

1. Ensuring that all foods and beverages served and sold in schools meet or exceed the most recent Dietary Guidelines for Americans.
2. Increasing access to high-quality, affordable foods through new or improved grocery stores and healthier corner stores and bodegas.
3. Increasing the time, intensity, and duration of physical activity during the school day and in out-of-school programs.
4. Increasing physical activity by improving the built environment in communities.
5. Using pricing strategies — both incentives and disincentives — to promote the purchase of healthier foods.
6. Reducing youths’ exposure to the marketing of unhealthy foods through regulation, policy, and effective industry self-regulation.