The Good and the Bad of Self-Monitoring of Blood Glucose

Abstract

Perhaps the greatest advance in technology for diabetes care in the past 20 years was the development and application of self-monitoring of blood glucose. This option has given the patient the opportunity to assess glucose control from moment to moment, allowing appropriate and prompt action to recognize and remedy hypoglycemia. No one would argue that this strategy is of considerable value to patients who are motivated to maintain close surveillance of their glucose levels. With the advent of an epidemic of acquired immunodeficiency syndrome (AIDS), however, we in the health-care field have become cognizant of the risks of inadvertent exposure to the virus that causes AIDS (1). Traditionally, this risk has focused on needle-stick and mucosal surface exposures, but more recently, the risk of exposure in less obvious ways has been of increasing concern. The use of gloves during activities that may expose one to the virus and the practice of safe needle disposal, as mandated by the Occupational Safety and Health Administration (OSHA), have reduced the risk of mucosal, skin, and parenteral exposure to patient blood and fluids. The protective value of adherence to the OSHA blood-borne pathogen exposure control measures that recommend the use of gloves when handling blood or items visibly stained with blood has reassured us. Such items include log books and papers, meters, and surfaces that are contaminated by patients who monitor blood glucose. They also include the sharps, cotton balls, and tissue to which health-care workers are exposed. All these items must be handled by using universal, standard precautions. Although the risk of human immunodeficiency virus (HIV) or one of the hepatitis virus infections for endocrinologists or diabetologists and their staff may seem to be almost nil, it is not zero and may be higher than we recognize (2). The potential cost of carelessness in facing these risks can be substantial. The review and processing of home blood glucose monitoring data and monitors as well as other associated procedures do involve some risk. Therefore, caution is warranted, and this commentary merits the attention of all those at risk. Transmission of HIV by needle-stick exposure to HIV-positive blood is extremely low (on the order of 0.3 to 0.4%) but remains a risk nevertheless (3). Actually, the risk of acquiring hepatitis B as a result of exposure to the blood of a carrier of hepatitis B is significantly higher. Hepatitis B can be fatal in some cases. The risk of contracting HIV infection after contact with the virus and subsequent contact with an area of broken skin or mucosa is not insignificant. Although the infectivity of viral agents including HIV and hepatitis viruses in blood wanes appreciably with drying time, the risk does not likely ever become zero. Everyone who is at risk of exposure to hepatitis B should receive the vaccine for this virus. Unfortunately, no such protection is yet available for HIV or for hepatitis C and other hepatitis viruses, which may also be transmitted through contact with infected blood (4,5). Procedures for the avoidance of and the management of exposure to these viruses must be established by physicians and institutions (6). The risk to individual practitioners is cause for particular concern. Appropriate reporting of such exposure to health agencies (private and public) is essential, as is adherence to proper procedures for eliciting a history of infection with HIV or hepatitis B virus or risk factors from the patient whose body fluid was responsible for the exposure. The opportunity to test the blood of the patient is dependent on state regulations. The testing of the blood of the exposed person is fairly standardized, involving a baseline sample of blood and fol