Careful glucose monitoring is essential for patient self-management of IR and T2D. In one recent study, 70% of patients with T2D who tested themselves daily were able to keep their A1C’s below 8%. Among those who did not, only 18% maintained A1C’s below 8% (Harris MI, et al. Diabetes Care 1999; 22:403–408).

The benefits of close monitoring and tight control are clear: 35% reductions in microvascular complications, 25% reduction in mortality, and 18% reduction in fatal and non-fatal MI, according to the UK Prospective Diabetes Study (UKPDS. Diabetes Care 2003; 26(suppl 1):S28–S32).

Yet many patients find it very difficult to comply. It is essential to identify each patient’s stumbling blocks to self-monitoring and try to address them.

According to Dr. Richard Beaser, of Boston’s Joslin Diabetes Center, most common reasons patients cite for non-compliance include: the pain and inconvenience of needle-stick testing; impaired dexterity or difficulty managing the testing equipment (especially in elderly patients); difficulty remembering to monitor owing to age-associated cognitive impairment; difficulty interpreting and understanding the meaning of the numbers; lack of insurance coverage for testing supplies.

Beyond these, many patients hold a firm though mistaken belief that they can “just tell” when their glucose is high, and they don’t need to test. “They think they can feel it, but testing proves that they cannot,” said Dr. Beaser, adding that it is very important to disabuse patients of this notion.