Self-monitoring Of Blood Glucose In Patients Research Articles

679-P: Costs and Cost-Effectiveness of the FreeStyle Libre System vs. Blood Glucose Self-Monitoring in Patients with Type 2 on MDI Insulin Treatment in Israel

Introduction: Frequent glucose monitoring is essential to obtaining glucose control. We assessed the costs and cost-effectiveness of using the FreeStyle Libre® Flash Continuous Glucose Monitoring system (FSL) compared to self-monitoring of blood glucose (SMBG) in people with type 2 diabetes treated with multiple daily insulin injections (T2D MDI) from a healthcare payer perspective in Israel. Methods: We calculated the incremental cost per quality adjusted life year (QALY) gained. Glucose monitoring costs are based on actual costs of FreeStyle Libre®, strips and lancets, assuming full adherence to monitoring. Severe hypoglycemic events (SHE) and diabetic ketoacidosis (DKA) costs are based on real-world data from Israel and the Israeli Ministry of Health list price. Costs are presented in Israeli Shekel (ILS) and $US. The incidence rates of SHE and DKA are based on real-world data from a large cohort of patients in France. Due to the short time horizon of this analysis, we assumed no mortality differences between the two monitoring alternatives. Utility increments for the use of CGM vs. SMBG, decrease in HbA1C and disutility for SHE and DKA events are based on estimates from the literature. The analysis was conducted over a 5-year time horizon, applying an annual discount rate of 3% on costs and outcomes. One way sensitivity analyses were performed on difference in costs. Results: FreeStyle Libre® use is associated with a cost increase of ILS 27,021 ($US 8,444) and an increase of 0.26 QALYs, generating an incremental cost-effectiveness ratio of ILS 103,977 ($US 32,493) per QALY gained. These results are highly sensitive to changes in costs of glucose monitoring. Conclusion: Assuming a willingness to pay threshold of $US 43,600 per QALY gained (GDP per capita in Israel in 2020) , the FreeStyle Libre® system is a highly cost-effective glucose monitoring alternative to SMBG for T2D MDI patients in Israel. Disclosure D.Greenberg: Advisory Panel; Abbott Diabetes, Consultant; Geffen Medical, Israel.

Problems of blood glucose self-monitoring in patients with diabetes mellitus

Glycemic self-monitoring is essential in  the  treatment of  diabetes mellitus. Compliance with the  recommendations for  selfmonitoring of glycemia is an important condition for the prevention of diabetes complications. The article provides a review of the problems associated with blood glucose self-monitoring faced by diabetic patients and doctors. These include low frequency of blood glucose self-monitoring, technical errors in glucose measurements, errors in keeping a diary and errors in using measurement data to diabetes control. The blood glucose monitoring system, which includes the glucometer, test strips, application, сloud for data storage can be used for blood glucose self-monitoring in patients with diabetes mellitus. The article discusses the features and advantages of the blood glucose monitoring system. The advantages of the glucometer are the no сoding technology and the following options: аpplication of additional amount of blood to the test strip; adding meal marks, testing as the measurement results compare with targets and informing about it; storage a large number of measurement results. In addition to the standard blood glucose measurement, the glucose meter and the application offer many features to improve blood glucose self-monitoring that can help to improve diabetes management: automatic transferring measurement results to smartphone or tablet; saving notes in logbook; display of glucose trends and testing as they compare with targets; offering quick and valuable tips for critical high/low glucose values.

POSA294 Meta-Analysis of Effectiveness of Self-Monitoring of Blood Glucose in Type 2 Diabetes

Self-monitoring of blood glucose (SMBG) has been shown effectiveness among patients with type 2 diabetes. This meta-analysis aims to synthesize available published data regarding the use of SMBG in patients with type 2 diabetes.

Важность самоконтроля гликемии в лечении сахарного диабета в условиях современности

Diabetes mellitus is a chronic disorder associated with microvasular and macrovascular complications, the prevention of which is an important challenge of modern medicine. Contemporary methods for diabetes management rely on the active involvement of the patient. Self-monitoring of blood glucose (SMBG) provides the basis for efficient antihyperglycemic therapy and prevention of hypoglycemia, as well as for the improvement of patient adherence to treatment. The importance of SMBG has further increased during the COVID-19 pandemic, since the adequate glycemic control can reduce the risk of COVID-19 infection and the disease severity in patients with DM. The recommended frequency of SMBG in patients with DM is discussed. A variety of glucose meters are available for measurement of blood glucose. Compliance with accuracy standards, simplicity and convenience for patients are the important criteria for selecting the glucose meter.

Weekly Insulin Becoming a Reality

Insulin was first isolated in 1921 and developed as a therapeutic agent in the 1920s. The initial crude preparations were injected multiple times daily because of their short duration of action. Consequently, there were many attempts to develop insulin preparations with prolonged biological availability in the hope that less frequent once-daily administration would be feasible (1). A host of such preparations were introduced, including protamine insulin, protamine zinc insulin, surfen insulin, globin insulin, iso-insulin, isophane insulin (NPH), and insulin zinc suspensions (lente insulins) (1) (Fig. 1). The goal was mainly to reduce the number of injections and thus the patient burden. Yet, with the development of a radioimmunoassay for insulin (2), it became apparent that physiologic insulin secretion involved two components: meal-related insulin secretion with postprandial spikes and basal insulin secretion that remains relatively constant with some minor pulsatility (3). Subsequently, as modern insulin therapy evolved, facilitated by patient self-monitoring of blood glucose (4,5), it became apparent that the inherent peaks in basal insulin preparations, such as with the nonsoluble NPH or lente insulins, created risk of hypoglycemia, especially if the insulin vials were not correctly rolled to create a proper suspension. Moreover, these insulins did not have sufficiently long duration of action to be used once daily. Consequently, in addition to making them soluble, two of the goals in development of basal insulin analogs, such as insulin glargine and insulin detemir, were to eliminate insulin peaks and to prolong the action to approach 24 h (6,7). Second-generation basal insulin analogs, such as insulin degludec and insulin glargine U300, came with …

Development of a Predictive Model for Glycated Hemoglobin Values and Analysis of the Factors Affecting It

Background: Glycated hemoglobin (HbA1c), which reflects the patient's blood sugar level, can only be measured in a hospital setting. Therefore, we developed a model predicting HbA1c using personal information and self-monitoring of blood glucose (SMBG) data solely obtained by a patient.Methods: Leave-one-out cross-validation (LOOCV) was performed at two university hospitals. After measuring the baseline HbA1c level before SMBG (Pre_HbA1c), the SMBG was recorded over a 3-month period. Based on these data, an HbA1c prediction model was developed, and the actual HbA1c value was measured after 3 months. The HbA1c values of the prediction model and actual HbA1c values were compared. Personal information was used in addition to SMBG data to develop the HbA1c predictive model.Results: Thirty model training sessions and evaluations were conducted using LOOCV. The average mean absolute error of the 30 models was 0.659 (range, 0.005–2.654). Pre_HbA1c had the greatest influence on HbA1c prediction after 3 months, followed by post-breakfast blood glucose level, oral hypoglycemic agent use, fasting glucose level, height, and weight, while insulin use had a limited effect on HbA1c values.Conclusions: The patient's SMBG data and personal information strongly influenced the HbA1c predictive model. In the future, it will be necessary to develop sophisticated predictive models using large samples for stable SMBG in patients.

Gestational Diabetes Mellitus: Diagnosis and Glycemic Control

Gestational diabetes mellitus (GDM) is a major medical complication of pregnancy, and it is related with poor perinatal outcomes and long-term risk of type 2 diabetes. Therefore, adequate diagnosis and treatment are essential to improve pregnancy outcome. Both one-step, 75-g oral glucose tolerance test (OGTT) and two-step, 50- and 100-g OGTTs can be used for diagnosing GDM. The cut-off points of 100-g OGTT are used for the criteria of Carpenter-Coustan. The incidence of GDM can be increased about 2 to 3 times using the one-step method compared to the two-step approach. The mainstay of treatment is composed of life-style management, including exercise and medical nutritional therapy, and insulin therapy. Considering the Korean health-care system, oral hypoglycemic agents cannot be the first-line choice, and intensification of insulin treatment depends on patient self-monitoring of blood glucose. Furthermore, all treatments should be tailored to patient condition. Keywords: Diagnosis; Gestational diabetes mellitus; Glycemic control; Oral glucose tolerance test

2264-PUB: Status of Self-Monitoring of Blood Glucose and Its Influencing Factors among Patients with Diabetes in Shanghai

Objective: To investigate the status of self-monitoring of blood glucose (SMBG) among patients with type 2 diabetes mellitus in Shanghai and analyze the factors affecting the frequency of SMBG. Methods: A total of 987 Chinese subjects with type 2 diabetes mellitus aged 20 to 80 years old was included in the present study from August 2017 to December 2017. A standard questionnaire was completed. The frequency of SMBG and related factors of hyperglycemia were analyzed. The subjects were divided into two groups according to the frequency of SMBG. The relatively high frequency group (RHF) (more than twice a week) and the relatively low frequency group (RLF) (one and twice a week). Results: Among all the subjects, 337 (34.2%) of them were in the RHF group, and 648 (65.8%) were in the RLF group. The number of patients who monitored blood glucose three times a day and more than three times a day was less (16 and 43, 1.6% and 4.4% respectively). Majority of patients adjusted their blood glucose levels through exercise (38.9%) and diet (38.1%), rather than drug (7.7%) after SMBG. Other methods (15.2%) were also used to alleviate hyperglycemia. Multivariate logistic regression analyses showed that age, duration of diabetic history, glycated hemoglobin, educational levels, insulin usage were factors influencing the frequency of SMBG in patients. Conclusions: The current status of SMBG among diabetic patients in Shanghai is not optimistic, in which the frequency of SMBG is relatively low. It is of great importance to increase the frequency of SMBG in controlling blood glucose levels. Disclosure L. Wei: None. Y. Zeng: None. Y. Xiao: None. L. Ji: None. M. Liu: None. Funding National Natural Science Foundation of China (81570778)

Titrating insulin in patients with type 2 diabetes using a structured self-monitoring blood glucose regimen.

Self-monitoring of blood glucose (SMBG) can inform on the timing of hyperglycaemia, but there is currently no standardised approach to utilising these data to improve glycaemic control in patients with type 2 diabetes. To assess the improvement in glycaemic control when an insulin titration algorithm was used in combination with SMBG in patients with poorly controlled, insulin-treated type 2 diabetes. This 6-month prospective study recruited 39 poorly controlled (glycated haemoglobin (HbA1c) ≥8.5%; 69.4 mmol/mol) type 2 diabetes subjects using twice-daily biphasic insulin from two state hospitals in Tshwane, South Africa. Patients were asked to perform structured SMBG over 4 weeks and return monthly for consultations where physicians titrated insulin doses using an algorithm guided by the data collected. The primary endpoint was the trend in HbA1c measured at baseline and 3 and 6 months. Mean HbA1c decreased over the study period by 1.89% (95% confidence interval (CI) -2.46 - -1.33; p<0.001). The hypoglycaemic event rate (<4.0 mmol/L) was 33.08 events per patient year. Total daily insulin use increased by a mean of 40.12 units over the study period (standard error 7.7; p<0.001) and weight increased by an average of 3.98 kg (95% CI 2.56 - 5.41; p<0.001). Monthly algorithmic insulin titration guided by structured SMBG can markedly improve glycaemic control in patients with type 2 diabetes by aggressively increasing insulin doses not previously expected in this population, with moderate hypoglycaemic events and weight gain observed.

Cost-effectiveness analysis of real-time continuous monitoring glucose compared to self-monitoring of blood glucose for diabetes mellitus in Spain.

Self-monitoring of blood glucose (SMBG) is recommended to monitor glycaemic levels. The recent development of real-time continuous glucose monitoring (RT-CGM) enables continuous display of glucose concentration alerting patients in the event of relevant glucose fluctuations, potentially avoiding hypoglycaemic events and reducing long-term complications related to glycosylated haemoglobin (HbA1c) levels. This paper aims to evaluate the cost-effectiveness of RT-CGM compared to SMBG in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) which should support decision-making on public funding of RT-CGM in Spain. We performed a systematic review and meta-analyses on the effectiveness of RT-CGM in the reduction of HbA1c levels and severe hypoglycaemic events. A cost-effectiveness analysis was conducted using a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives for a lifetime horizon from the perspective of the Spanish Health Service. The effectiveness measure was quality-adjusted life years (QALYs). We ran extensive sensitivity analyses, including a probabilistic sensitivity analysis. Real-time continuous glucose monitoring provides a significant reduction of HbA1c for T1DM (13 studies; weighted mean difference (WMD)=-0.23%, 95% CI: -0.35, -0.11) and T2DM (5 studies; WMD=-0.48%, 95% CI: -0.79, -0.17). There were no statistically significant differences in the rate of severe hypoglycaemic events in T1DM (9 studies; OR=1.16, 95% CI: 0.78, 1.72) or T2DM (no severe hypoglycaemic events were reported in any study). In the base case analysis, RT-CGM led to higher QALYs and health care costs with an estimated incremental cost-effectiveness ratio of €2554723 and €180553 per QALY for T1DM and T2DM patients respectively. Sensitivity analyses revealed that the study results were robust. Real-time continuous glucose monitoring is not a cost-effective technology when compared to SMBG in Spain.

Effect of Insulin Analogs on Frequency of Non–Severe Hypoglycemia in Patients with Type 1 Diabetes Prone to Severe Hypoglycemia: Much Higher Rates Detected by Continuous Glucose Monitoring than by Self-Monitoring of Blood Glucose—The HypoAna Trial

Hypoglycemia is an increasingly important endpoint in clinical diabetes trials. The assessment of hypoglycemia should therefore be as complete as possible. Blinded continuous glucose monitoring (CGM) provides an improved opportunity to capture asymptomatic and nocturnal events. Here we report results from the HypoAna trial comparing all-analog-insulin therapy (aspart/detemir) with all-human-insulin therapy (neutral protamine Hagedorn/regular) on non-severe hypoglycemia (symptomatic and asymptomatic hypoglycemia) as assessed by blinded CGM and compared with data obtained by self-monitoring of blood glucose (SMBG) in patients with type 1 diabetes and recurrent severe hypoglycemia. Fifty-three patients completed a substudy of 4 × 3 days of blinded CGM. CGM traces were reviewed for hypoglycemic events lasting 15 min or longer. At the threshold ≤3.9 mmol/L, the per-protocol analysis demonstrated a 40% rate reduction (95% confidence interval [CI] 20%-60%; P = 0.002) in nocturnal non-severe hypoglycemia during analog treatment, mainly due to a 40% rate reduction (95% CI 0%-70%; P = 0.03) of nocturnal asymptomatic hypoglycemia. Similar nonsignificant trends were seen at the glucose threshold ≤3.0 mmol/L. Overall CGM-detected that nocturnal asymptomatic hypoglycemia ≤3.9 mmol/L was ∼17 times more frequent than SMBG-detected episodes (52 vs. 3 events/patient-year). This translates into a time needed to treat one patient with insulin analogs to prevent one episode that is 34 times shorter using CGM data than SMBG data (1.4 vs. 47 weeks). Capturing hypoglycemic events by the conventional method of SMBG in patients with impaired awareness reveals only a limited number of events. Blinded CGM can provide more complete data, particularly in terms of asymptomatic and nocturnal events.

Factors associated to adherence to blood glucose self-monitoring in patients with diabetes treated with insulin. The dapa study

ObjectiveTo assess adherence to self-monitoring of blood glucose and the main factors associated with it, particularly those related to self-perception of glycemia, in patients with diabetes on insulin therapy. Patients and methodsAn epidemiological, observational, prospective, multicenter study conducted in standard clinical practice in primary care, outpatient centers, and hospitals from different Spanish regions. Sociodemographic, clinical and treatment data were collected. Patients were considered adherent to self-monitoring if they performed the minimum number of controls recommended by the Spanish Society of Diabetes (SED). ResultsAdherence was shown in 61.6% of patients. Factors associated to adherence included treatment with less than three insulin injections daily (OR 2.678; 95% CI 2.048–3.5029; p<0.001), presence of peripheral vascular disease (OR 1.529; 95% CI 1.077–2.171; p=0.018), alcohol abstinence (OR 1.442; 95% CI 1.118–1.858; p=0.005), and collection of the glucose test strips from the pharmacy (OR 1.275; 95% CI 1.026–1.584; p=0.028). Adequate self-perception of glycemia was found in 21.4% of patients. ConclusionsOur results show a suboptimal adherence to the recommended protocol for blood glucose self-monitoring in patients with diabetes on insulin therapy. Independent variables associated to good adherence were treatment with less than three insulin injections daily, presence of peripheral vascular disease, alcohol abstinence, and collection of glucose test strips from the pharmacy.

Factores asociados a la adherencia al autoanálisis de la glucemia capilar en personas con diabetes en tratamiento con insulina. Estudio dapa

ObjectiveTo assess adherence to self-monitoring of blood glucose and the main factors associated with it, particularly those related to self-perception of glycemia, in patients with diabetes on insulin therapy. Patients and methodsAn epidemiological, observational, prospective, multicenter study conducted in standard clinical practice in primary care, outpatient centers, and hospitals from different Spanish regions. Sociodemographic, clinical and treatment data were collected. Patients were considered adherent to self-monitoring if they performed the minimum number of controls recommended by the Spanish Society of Diabetes (SED). ResultsAdherence was shown in 61.6% of patients. Factors associated to adherence included treatment with less than three insulin injections daily (OR 2.678; 95% CI 2.048– 3.5029; p <0.001), presence of peripheral vascular disease (OR 1.529; 95% CI 1.077 – 2.171; p=0.018), alcohol abstinence (OR 1.442; 95% CI 1.118 – 1.858; p=0.005), and collection of the glucose test strips from the pharmacy (OR 1.275; 95% CI 1.026 – 1.584; p=0.028). Adequate self-perception of glycemia was found in 21.4% of patients. ConclusionsOur results show a suboptimal adherence to the recommended protocol for blood glucose self-monitoring in patients with diabetes on insulin therapy. Independent variables associated to good adherence were treatment with less than three insulin injections dailyu, presence of peripheral vascular disease, alcohol abstinence, and collection of glucose test strips from the pharmacy.

Opportunity Cost and Policy: A Utilization Review of Self-monitoring of Blood Glucose in Manitoba, Canada

PurposeRecently, there has been a re-evaluation of the frequency, benefits, and costs associated with self-monitoring of blood glucose (SMBG). Based on little evidence of the benefit of frequent SMBG in patients with diabetes not using insulin, new guidelines and test strip limit policies have been suggested and implemented in various Canadian jurisdictions to promote a more selective practice of SMBG. The objective of this study was to assess the overall utilization and cost associated with test strips and lancets for SMBG in Manitoba from 2000 to 2013 as well as to explore the policy implications of the implementation of test strip quantity limits and its impact on overall and government costs. MethodsAn analysis of prescription claims for blood glucose test strips (BGTSs) and lancets for all patients with diabetes in Manitoba from 2000 to 2013 was conducted. In each year, patients were stratified into 4 mutually exclusive hierarchical groups according to most intensive diabetes treatment. Test strip and lancet utilization and cost were assessed for each group in each year, and the potential cost savings associated with implementation of a BGTS limit policy was projected using autoregressive integrated moving average models. FindingsIn the year 2000, 8 million test strips were dispensed in Manitoba, increasing by 170% to 21.7 million test strips in 2013. Insulin users accounted for the majority of test strip use. However, based on potential implementation of test strip limit policies, 95% of the reduction of test strip use is predicted to occur in the groups not using insulin. Based on current trends, the 5-year predicted additional cost associated with not implementing a test strip limit policy similar to that implemented in other Canadian provinces was estimated to be a total of $12.35 million. ImplicationsImplementation of the guideline-based policy limits is predicted to produce considerable savings, with 95% of potential savings occurring in patients not using insulin. There is, therefore, a significant opportunity cost associated with not implementing a policy to reduce BGTS utilization by patients with diabetes in Manitoba. Based on the lack of evidence to suggest significant outcome improvements with long-term frequent SMBG by patients not using insulin, more selective use of test strips for SMBG could allow for significant cost savings that could be redirected to other programs and interventions for the growing population of patients with diabetes in Manitoba.

Advances in Patient Self-Monitoring of Blood Glucose.

In 2 articles of the present issue, Bendini et al report about performance results obtained with 2 blood glucose monitoring systems of the Contour Next platform. Using several analysis methods, the authors demonstrate a very high accuracy, which meets all actual regulatory performance criteria. With consistent MARD results < 5% under daily routine conditions, this meter platform is finally fulfilling the accuracy request as set forth by the American Diabetes Association already in the late 1980s. This meter platform is representative for the successful effort of the device manufacturers who were consequently improving the analytical performance of blood glucose meters during the Past 2 decades, starting with an MARD of 12-15% at the end of the past century and reaching an excellent accuracy < 5% today.

An Unanswered Question about Diabetes Mellitus.

Dear Editor, Diabetes Mellitus is so prevalent all around the world. As known, Diabetes is accounted among the high morbid and mortal diseases. As a nurse I had a question in mind, I wanted to know what is the best or assuring criterion to judge on the improvement in diabetic patients?. I asked some physicians, some of them emphasized that fasting blood sugar (FBS) and postprandial blood sugar are the important items in evaluating the patients' conditions. Others insisted on evaluating based on the glycosylated hemoglobin (HbA1c) test results. While searching on the internet with the keyword mellitus, I found five articles in your journal's archive including the term diabetes (1-5). Three of them were included the term in the title or keywords: two qualitative researches and a randomized controlled trial (1-3). I read those articles and I found them so great and professionally written. What made me to write this letter to you was that in the studies conducted to evaluate the effects of different complementary medicines on diabetic patients, I found no assuring criterion to evaluate the patients' improvement. Most of the worldwide published studies evaluated the patients' improvement through laboratory tests. For example one of the published studies in your journal evaluated the patients' improvement based on their blood sugar levels in the morning (fasting blood sugar) and in the afternoon (blood sugar at 5 pm) (1). In a clinical review published in 2009 reviewing the clinical evidence supporting complementary and alternative medicine interventions for improving glycemic control in type 2 diabetic patients, HbA1c and fasting blood glucose (FBG) levels were reported as the criteria for evaluating the effectiveness of specific therapies (6). Based on The National Diabetes Education Program, the intermediate outcomes in glucose control are achieving/maintaining healthy weight, self-monitoring of blood glucose (SMBG) levels in the target range, HbA1c levels below 7%, blood pressure below 130/80 mm Hg and Low-density lipoprotein cholesterol (LDL) levels below 100 mg/dL (7). American association introduced patient SMBG and HbA1c to assess the effectiveness of the management plan on glycemic control and also considered medical history, physical examination, laboratory evaluation, and referrals as the components of comprehensive evaluation. The authors of this standard recommended that patients should do SMBG 6-8 times daily, and perform HbA1c test 2-4 times a year or even more if needed (8). However, there is the fact that the amount of blood glucose depends on food composition, portion size (the amount of consumed food) and timing of meals and snacks (9). Also, HbA1c test is affected by erythrocyte turnover and hemoglobin variants. In addition, sometimes the laboratory test results do not match the clinical conditions of the patients (8). Both of the blood glucose (fasting or postprandial) and HbA1c are affected by different conditions and may represent false interpretations of patients' health, however these two items are being used frequently to judge patients' conditions worldwide. As a conclusion, I found each item for evaluating the effectiveness of the management plan on glycemic control faces with limitations. Finally this question is still in my mind that what is the best or assuring criterion to judge the improvement in diabetic patients?. It seems that researches are needed to find the precise answer to this question.

Value and Utility of Self-Monitoring of Blood Glucose in Non-Insulin-Treated Patients With Type 2 Diabetes Mellitus

Self-monitoring of blood glucose (SMBG) levels provides important information regarding glycemic control for patients with diabetes, and is recommended by European and American diabetes organizations as an essential adjunct to periodic glycated hemoglobin (HbA) level monitoring. The benefits of SMBG in improving glycemic control in patients with type 1 diabetes and those with type 2 diabetes (T2DM) who are being treated with insulin are well recognized. In contrast, the potential role of SMBG in patients with T2DM not treated with insulin remains controversial, which may lead to underutilization of SMBG in this population. Structured SMBG, introduced aspart of a treatment intervention, has been associated with modest but significant improvements in HbA1c levels in patients with T2DM who are not taking insulin as part of their management plan. Patient-obtained readings provide valuable real-time feedback on glucose responses to meals and exercise, and provide the patient with guidance on the day-to-day management of their diabetes. Studies have shown that when patients perform self-monitoring as part of their treatment interventions, support through appropriate educational initiatives is critical to ensure that patients understand the rationale for SMBG. Patients should be trained in correct testing technique and data recording for SMBG, as well as target blood glucose and goal HbA1c levels so that they will know when their SMBG readings are out of range. Technology has a potential role in facilitating SMBG-based interventions by improving patient-physician communication and optimizing glycemic control through the use of remote data uploading, data analysis tools, and, perhaps, even text messaging. This review outlines the benefits of SMBG in the management of patients with T2DM not treated with insulin, and highlights strategies for improving the effectiveness of SMBG-based treatment interventions in this population.

Use of Blood Glucose Meters Among People With Type 2 Diabetes: Patient Perspectives

The clinical value of regular self-monitoring of blood glucose (SMBG) in people with type 2 diabetes remains controversial. Some studies have found either no significant difference in A1C outcomes in groups performing or not performing SMBG1 or no evidence that SMBG confers benefits for outcomes other than A1C, such as mortality, long-term complications of diabetes, body weight, patient satisfaction, or quality of life.2 These studies2,3 have also indicated that there is “little indication that [patients are] using self-monitoring to effect and maintain behavior change.” One reason typically cited for the apparent lack of efficacy for SMBG in patients with type 2 diabetes is that patients simply do not adequately follow recommendations from their health care professionals.4 To date, few studies have explored the patients' perspective on SMBG beyond including standardized scales of “well-being” in more mechanized studies. In addition to formal recommendations from professional diabetes associations, leading diabetes clinicians and patient advocates with whom I am associated also disagree about the role of SMBG in the management of type 2 diabetes. My discussions with these individuals have provided further context for this topic. From them, I have heard:

What are the barriers faced by patients using insulin? A qualitative study of Malaysian health care professionals&amp;rsquo; views

BackgroundPatients with type 2 diabetes often require insulin as the disease progresses. However, health care professionals frequently encounter challenges when managing patients who require insulin therapy. Understanding how health care professionals perceive the barriers faced by patients on insulin will facilitate care and treatment strategies.ObjectiveThis study explores the views of Malaysian health care professionals on the barriers faced by patients using insulin.MethodsSemi-structured qualitative interviews and focus group discussions were conducted with health care professionals involved in diabetes care using insulin. Forty-one health care professionals participated in the study, consisting of primary care doctors (n = 20), family medicine specialists (n = 10), government policymakers (n = 5), diabetes educators (n = 3), endocrinologists (n = 2), and one pharmacist. We used a topic guide to facilitate the interviews, which were audio-recorded, transcribed verbatim, and analyzed using a thematic approach.ResultsFive themes were identified as barriers: side effects, patient education, negative perceptions, blood glucose monitoring, and patient adherence to treatment and follow-up. Patients perceive that insulin therapy causes numerous negative side effects. There is a lack of patient education on proper glucose monitoring and how to optimize insulin therapy. Cost of treatment and patient ignorance are highlighted when discussing patient self-monitoring of blood glucose. Finally, health care professionals identified a lack of a follow-up system, especially for patients who do not keep to regular appointments.ConclusionThis study identifies five substantial barriers to optimizing insulin therapy. Health care professionals who successfully identify and address these issues will empower patients to achieve effective self-management. System barriers require government agency in establishing insulin follow-up programs, multidisciplinary diabetes care teams, and subsidies for glucometers and test strips.

Self-monitoring practice in patients with type 2 diabetes mellitus: data from regional mobile diabetes centre

Aims. To determine popularity and variants of blood glucose self-monitoring in patients with type 2 diabetes mellitus (T2DM) as wellas its correlation with efficiency of antihyperglycemic therapy. Materials and methods. Current study was carried out within the framework of mobile diabetes centre project. We analyzed 545 patients,assessing their clinical status, laboratory test results (including HbA1c levels) and self-monitoring frequency. Results. 49% of patients reported regular self-monitoring, while 25% conducted monitoring of both fasting and postprandial bloodglucose levels. Percentage of patients performing self-monitoring was found to be independent of age and length of diabetes experience,but correlated with insulin therapy and rating of chronic diabetic complications. Self-monitoring was associated with lower rate ofdiabetic decompensation and was much more common among patients on insulin therapy, being associated with statistically significantreduction of HbA1c levels. Conclusion. Self-monitoring is associated with greater efficiency of antihyperglycemic treatment in patients with T2DM on insulintherapy, as well as in those receiving oral agents only.