Self-monitoring of blood glucose

Abstract

Many would argue that the introduction of modern-day diabetes management started 30 years ago with the introduction of self-monitoring of blood glucose (SMBG) at home. While that may be true, it is interesting that many of today’s fundamental questions have yet to be answered. Furthermore, the technology itself continues to change, to improve and to better exist with our non-diabetes technology. For example, the first SMBG ‘apps’ are available now for smart-phones (iPhone), and we can expect the phones themselves to participate more directly with SMBG and diabetes management. Still, both researchers (and payors) continue to ask some fundamental questions. 1 What is the efficacy of SMBG for patients not requiring insulin therapy? 2 What is the optimum frequency of SMBG for patients who do require insulin therapy? 3 What is the role of software to assist in data management for SMBG (for both patients and clinicians)? 4 What is the cost effectiveness of SMBG for all of the different patient populations with diabetes? 5 What is the ideal chemistry which results in the least amount of interfering substances with SMBG? 6 What is an acceptable accuracy for SMBG both at home and in the hospital? The accuracy question is more important than ever since all continuous glucose monitoring (CGM) for now are calibrated with SMBG results. 7 What is the best strategy for teaching patients how best to use their SMBG data? 8 What is the best way to integrate SMBG with insulin pump therapy? 9 What is the role of SMBG with today’s CGM devices? 10 What will the role of SMBG be 5–10 years from now with future CGM devices? These are just some of the questions which need more thought and study as we move into 2011. In this chapter we have selected papers that appeared in the PubMed on this topic and chose those we thought were most influential in this area. We have then addressed many of these topics although answers are far from clear for many of them. Although SMBG is not ‘new’ technology, much research needs to be completed before we fully understand this tool’s full impact, particularly as CGM becomes more popular.