Improving Results from Home Blood-Glucose Monitoring: Accuracy and Reliability Require Greater Patient Education as Well as Improved Technology

Abstract

Clinicians often sit in their offices or surgeries and wonder why the home blood-glucose monitoring record prepared by the patient is at odds with the objective measurement of control given by hemoglobin A1c (HbA1c). In this issue of the Journal, Skeie et al. (1) point to one possible facet of this discrepancy. They suggest that the performance of instruments for blood-glucose monitoring is worse in the hands of the patients than in the hands of trained laboratory personnel. Furthermore, few if any of the instruments, when used by the patients, gave performances that would meet established guidelines for quality of results (2)(3). The final decade of the last century was crucial for diabetes management. Evidence from the Diabetes Control and Complications Trial (4) in the US, which involved type 1 diabetic patients, and from the United Kingdom Prospective Diabetes Study in the United Kingdom, which involved type 2 diabetic patients (5)(6), confirmed the long-held, but previously somewhat unsubstantiated, view that control of blood glucose was important in delaying the onset or preventing the development of complications. Obtaining and maintaining euglycemia in diabetic patients, however, remains an elusive goal for many, but importantly, the evidence suggests that improving outcome is a continuum, i.e., benefit accrues for any …