Home Blood Glucose Monitoring in Type 2 Diabetes

Abstract

The Diabetes Control and Complications Trial (DCCT) (1) would not have been possible without the advent of several technologies, including self-monitoring of blood glucose (SMBG). After the results of that landmark study were reported in 1993, SMBG was considered the standard of care for type 1 diabetic patients. The same was true for insulin-requiring type 2 diabetic patients after the report of the UK Prospective Diabetes Study (UKPDS) in 1998 (2). However, cost pressures have now caused some to question SMBG in type 1 diabetes (3), and we continue to struggle with conflicting evidence for those patients with type 2 diabetes not receiving insulin. The fundamental problem has been difficulty in trial design with many of the challenges carrying over from clinical trials to clinical practice. For example, is the patient with type 2 diabetes even willing and able to perform SMBG? And, based on the glucose data, is the patient engaged enough to make behavioral changes that would improve glucose control? And even for those individuals who are able to make significant lifestyle changes, will they be willing to initiate insulin therapy if indicated? From the provider's perspective, is there time to review the data and potentially intensify therapy with that information? Can the provider even easily access the data, especially if there is a large amount of information in the 2 or 3 weeks before a clinic appointment? If the clinician cannot download the data, will the patient be willing to share the information either with a paper logbook or perhaps a computerized tool such as a spreadsheet or even a smart-phone app? What becomes clear is that for data to …