Use Of Self-monitoring Of Blood Glucose Research Articles

Instruments for Self-Monitoring of Blood Glucose: Comparisons of Testing Quality Achieved by Patients and a Technician

Instruments for self-monitoring of blood glucose (SMBG) are increasingly used by patients with diabetes. The analytical quality of meters in routine use is poorly characterized. We compared SMBG performance achieved by patients and by a medical laboratory technician. Imprecision was calculated from duplicate measurements, and deviation as the difference between the first measurement and the mean of duplicate laboratory-method results (calibrated with NIST material). Analytical quality for five groups of SMBG instruments was compared with quality specifications for BG measurements. All participants completed a questionnaire assessing both SMBG training and use of the meters. We recruited 159 SMBG users from a hospital outpatient clinic and 263 others from 65 randomly selected general practices (total of 422). Most (two thirds) used insulin. CVs for the five meter types were 7%, 11%, 18%, 18%, and 20% in the hands of patients and 2.5-5.9% for the technician. For three of five meter types, patients' BG measurements had larger deviations from the laboratory results than did the technician's results. The technician's performance could not predict the patients'. No instrument when used by patients (but two operated by the technician) met published quality specifications. The analytical quality of patients' results was not related to whether they had chosen the instruments on advice from healthcare personnel (one-third of patients), were only self-educated in SMBG (50%), or performed SMBG fewer than seven times/week (62%). The analytical quality of SMBG among patients was poorer than, and could not be predicted from, the performance of the meters in the hands of a technician. We suggest that new instruments be tested in the hands of patients who are trained on meter use in a routine way.

GLUCOSE MONITORING IN TYPE 2 DIABETES

A major goal in the treatment of type 2 diabetes is to maintain blood glucose values in the normal or near normal range. A system of monitoring glycemic control, which includes self-monitoring of blood glucose (SMBG) by the patient, and frequent glycated protein assays, is an important tool for achieving this goal. Optimal use of SMBG by the patient is best accomplished through comprehensive glucose monitoring education, which includes appropriate monitor selection and use and strategies to use monitoring results to improve glycemic control.

Impact of Glucose Self-Monitoring on Non-lnsulin-Treated Patients With Type II Diabetes Mellitus: Randomized Controlled Trial Comparing Blood and Urine Testing

The goal of this study was to compare the relative efficacy and cost of self-monitoring of blood glucose (SMBG) with routine urine testing in the management of patients with type II (non-insulin-dependent) diabetes mellitus not treated with insulin. Fifty-four patients with type II diabetes mellitus, not treated with insulin, who had inadequate glucose control on diet alone or diet and oral hypoglycemic agents were studied. Patients performed SMBG or urine glucose testing as part of a standardized treatment program that also included diet and exercise counseling. During the 6-mo study, both the urine-testing and SMBG groups showed similar improvement in glycemic control; within each group, there were significant improvements in fasting plasma glucose (reduction of 1.4 +/- 3.2 mM, P less than 0.03) and glycosylated hemoglobin (reduction of 2.0 +/- 3.4%, P less than 0.01) levels. Seventeen (31%) of 54 patients actually normalized their glycosylated hemoglobin values, 9 in the urine-testing group and 8 in the SMBG group. Comparisons between the urine-testing and SMBG groups showed no significant differences in mean fasting plasma glucose (P greater than 0.86), glycosylated hemoglobin (P greater than 0.95), or weight (P greater than 0.19). In patients with type II diabetes mellitus not treated with insulin, SMBG is no more effective, but is 8-12 times more expensive, than urine testing in facilitating improved glycemic control. Our results do not support widespread use of SMBG in diabetic patients not treated with insulin.

Intensive insulin therapy: a personal and historical perspective.

Intensive therapy of Type I diabetes is a system of therapy in which the patient is the key partner in day-to-day management. A number of technical developments in the late 1970s led to the development of intensive therapy. Self-monitoring of blood glucose (SMBG) proved to be the major change agent that stimulated the revolution in diabetes management that is intensive therapy. One important event that stimulated widespread use of SMBG was the development of spring-loaded finger-pricking devices. The introduction of glycated hemoglobin measurements as an indicator of glycemic control over several weeks allowed quantitative assessment of glycemic control. The advent of continuous subcutaneous insulin infusion (CSII) stimulated thinking about insulin regimens. These advances have combined not only to facilitate development of intensive therapy as a strategy of diabetes management, but also to permit development of research protocols to assess the impact of such therapy on the chronic complications of diabetes.

Self-Monitoring of Blood Glucose

Self-monitoring of blood glucose (SMBG) is an essential tool in the management of diabetes. If properly used, SMBG values are employed by the patient to make immediate treatment decisions. The decisions are based on a predetermined action plan that consists of actions designed to achieve blood glucose values within a given target range. Optimal treatment of diabetes is guided by the knowledge of prevailing blood glucose levels. SMBG is an essential component of any intensive therapy program directed toward achieving meticulous glycemic control. SMBG enables therapeutic goals to be clearly defined and permits assessment of glycemic control during ordinary life, thus being complementary to glycated hemoglobin measurements. SMBG determinations are used on an ongoing basis by patients, to aid in the adjustment of the therapeutic regimen. Optimal use of SMBG requires the goals of treatment to be clearly defined and for patients to be taught proper interpretation of the data. Patients need to learn how to use the data to adjust food intake, exercise, or pharmacological therapy to achieve specific glycemic goals. SMBG is the only practical means of detecting asymptomatic hypoglycemia in the outpatient setting. SMBG may also be used to detect temporal glycemic patterns, so that therapy may be modified in an attempt to prevent hypoglycemia. A great advantage of SMBG is its use in intercurrent illness and other emergency situations, in which SMBG allows objective documentation of acute destabilization of diabetic control. Patients may be provided with a home management plan to use during illness. SMBG may be particularly important in children and adolescents who have wide day-to-day variations in activity. Instrumental to the use of SMBG is the choice of blood glucose targets. There should be defined blood glucose targets, individualized for the needs of each patient. Frequency of monitoring depends on the treatment program and varies considerably depending on the clinical situation. Knowledge of preprandial, bedtime, and nocturnal blood glucose concentrations is required to determine the appropriate basal and preprandial insulin doses. The best predictor of compliance with SMBG is the perception of improved control with such monitoring. Record keeping is essential to successful treatment, particularly if one is to consider the impact of previous responses. In response to blood glucose fluctuations, the patient must learn how to take appropriate action, predetermined with the diabetes management team. Keywords: blood glucose; insulin; meticulous control; treatment guidelines; dose adjustment; patterns; SMBG