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Self-monitoring blood glucose

Self-monitoring blood glucose

Article PubMed Self-monitoring blood glucose Hidden sugar consumption Google Scholar Self-monnitoring CG, Davidson JA. View Swlf-monitoring. Silva DD, Bosco AA. FGMs vlucose also give you a report on the daily pattern of your glucose levels. Br J Biomed Sci. Impact of blood glucose self-monitoring errors on glucose variability, risk for hypoglycemia, and average glucose control in type 1 diabetes: an in silico study. Control solution must be prescribed by a provider to be processed as a covered benefit.


7 Alarming Signs Your Blood Sugar Is Too High The question of whether routine self-monitoring Enhanced concentration alertness blood glucose Liver detoxification for a healthy liver has value remains unsettled. And Selfmonitoring leads to Self-monotoring questions. For example: Even if self-monitoring does prove to Self-monihoring unnecessary for many adults with type 2 diabetes not on insulin, might there still be people in this group who would benefit or circumstances that would require self-monitoring? With all the things that people with diabetes need to do, self-monitoring might not be the best thing you could do with your time. Instead, that time could be used for making other healthy behavior choices.

Self-monitoring blood glucose -

A study published in evaluated the responses from patients with non—insulin-dependent diabetes about their perceptions of self-monitoring of blood glucose. Several themes emerged from the study that may help explain why some patients derive a sense of benefit from the practice.

As in other situations in which physicians must de-escalate care, deprescribing self-monitoring of blood glucose requires eliciting patient goals and preferences, and, when possible, integrating those preferences with best practices based on the harms and benefits of self-monitoring.

The first step is identifying patients who may be good candidates for discontinuing self-monitoring, including those who have glycemic control at or close to the desired A1C goal using only oral agents and who are unlikely to require insulin soon.

Counseling techniques tailored to each type may aid in discussions around de-escalation of self-monitoring. If a patient agrees to de-escalation of care, the physician should next initiate a discussion on deprescribing self-monitoring of blood glucose.

This may be challenging and could require multiple visits. Physicians may also find helpful a validated tool to test patient confidence in their decision, such as the SURE questionnaire Table 1 14 , when developing individualized strategies.

Physicians should follow up periodically to revisit this conversation. The physician in this scenario, who is seeing A. for the first time, should begin by acknowledging their commitment to patient care, as well as eliciting A.

The physician should explain concepts with which A. may not be familiar, while providing a rationale for de-escalating self-monitoring of blood glucose given the most recent evidence and practice guidelines.

Nonetheless, some patients will naturally require more time than others to decide about de-escalation of self-monitoring, and the physician should expect to follow up and continue the conversation at future visits as needed. Malanda UL, Welschen LMC, Riphagen II, et al.

Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev. Young LA, Buse JB, Weaver MA, et al. Glucose self-monitoring in non—insulin-treated patients with type 2 diabetes in primary care settings: a randomized trial.

JAMA Intern Med. Yeaw J, Lee WC, Aagren M, et al. Cost of self-monitoring of blood glucose in the United States among patients on an insulin regimen for diabetes. J Manag Care Pharm. Wagner J, Malchoff C, Abbott G. Invasiveness as a barrier to self-monitoring of blood glucose in diabetes.

Diabetes Technol Ther. Franciosi M, Pellegrini F, De Berardis G, et al. The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies. Diabetes Care.

American Academy of Family Physicians. Don't routinely recommend daily home glucose monitoring for patients who have type 2 diabetes mellitus and are not using insulin.

Choosing Wisely. August 8, Accessed November 16, It is recommended for patients treated with insulin and is desirable for all patients with diabetes. Judicious use of SMBG data can help to improve glycemic control, select an anti-diabetic regimen, and provide powerful feedback to patients wishing to improve metabolic control.

Benjamin, MD, FACP, is an assistant professor of medicine at Tufts University School of Medicine and Director of Healthcare Quality at Baystate Medical Center in Springfield, Mass. Note of disclosure: Dr. Benjamin is a paid consultant to Becton Dickinson, which manufactures lancet devices.

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Volume 20, Issue 1. Previous Article Next Article. SMBG Use and Frequency. Recommending a Meter. Article Navigation.

Practical Pointer January 01 Self-Monitoring of Blood Glucose: The Basics Evan M. Benjamin, MD, FACP Evan M. Benjamin, MD, FACP. This Site. Google Scholar. Clin Diabetes ;20 1 — Get Permissions. toolbar search Search Dropdown Menu.

toolbar search search input Search input auto suggest. SMBG can aid in diabetes control by:. Table 1. Blood Glucose Meters. View large. View Large. Evans JMM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ, Morris AD: Frequency of blood glucose monitoring in relation to glycemic control: observational study with diabetes database.

Franciosi M, Pellegrini F, De Bernardis G, Belfiglio M, Nicolucci A: The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients. Diabetes Care. This is particularly important for people who are working with a registered dietitian because meal-time monitoring is necessary to develop an individualized meal plan that will promote glycemic control.

Noninsulin-requiring people with type 2 diabetes typically only have insurance coverage for 30 test strips per month unless their provider prescribes and justifies the need for more strips.

It is important for educators to work with patients to determine how their monthly allotment of strips will be used to obtain actionable information.

If their test strip allowance is limited, this may result in no SMBG testing on some days. Examples of SMBG Regimens 1. Using pattern management in decision-making. Some decisions such as treating hypoglycemia do not require multiple SMBG results to justify taking action. However, most clinical and lifestyle decisions, such as adjusting medication doses, changing food intake, or understanding the effects of exercise, will require three to four blood glucose results taken at the same time of day before taking action.

Pattern management involves both patients and providers performing a systematic review and analysis of the patients' recorded blood glucose levels.

Some available meters and software programs provide automated pattern detection. Regardless of how patterns are detected, the goal is to proactively make changes in lifestyle or the therapeutic regimen to resolve consistent patterns of high or low blood glucose and attain blood glucose targets.

A study by Wang et al. Diabetes educators can play a key role in teaching problem-solving skills. Encouraging individuals to write their blood glucose values in a logbook that allows testing times and results to be recorded in a linear and vertical manner facilitates the process of reviewing results Table 6.

There are also meters available that can detect blood glucose patterns and provide users with feedback. Additionally, the framework for interpreting SMBG records developed by Powers 19 provides the questions that need to be considered when assessing blood glucose results.

See related article in this issue, p. That framework groups questions in a three-step process: obtaining sufficient and accurate SMBG data; identifying all possible interpretations; and making individual plans and recommendations.

Sample SMBG Log Recording Results in a Linear and Vertical Manner 1. It is crucial for people with diabetes to understand all of the factors that can raise or lower their blood glucose. Unless this is clear, patients will not understand what action or lifestyle changes they need to undertake.

It is also important for patients and providers who are analyzing SMBG data to understand that the timing of a blood glucose test can provide valuable insight. For example, if fasting blood glucose results are not within the target range, this assesses the overnight effect of medication s taken the night before.

If postmeal blood glucose levels are above target, this assesses the adequacy of premeal diabetes medications in light of the meal eaten; if no medications are taken before meals, this assesses the effect of the meal. Table 7 provides direction regarding what to assess when trying to problem-solve out-of-range blood glucose levels.

Paired testing, through which blood glucose is checked before and again 1—2 hours after a meal, has gained attention in recent years. Research by Monnier et al. In such situations, diabetes educators should encourage individuals to focus their efforts on reaching their postprandial blood glucose targets.

It is important to remember that blood glucose testing alone is not sufficient to improve glycemic outcomes. A study by Rodbard et. al 22 , 23 showed that improvements in glycemic control occurred when structured SMBG was combined with comprehensive clinical education about SMBG data interpretation and use for medical providers.

Successful SMBG requires education; all patients who are prescribed a meter should also be provided with a referral for diabetes self-management education. It is not enough to understand how to operate a blood glucose meter and successfully perform a test.

The educational components of SMBG include two types of skills: operational how to operate the meter and interpretive how to interpret and act on SMBG results [i. The value of monitoring is realized when people with diabetes are able to competently and confidently perform SMBG and then analyze the resulting data to make self-care choices that positively affect their diabetes management.

It is crucial for SMBG results to be shared with patients' HCPs and considered when making clinical decisions. Between medical office visits, SMBG results may be the only feedback individuals have to critically assess their glycemic control and management. Educators and HCPs must not only teach patients how to correctly perform SMBG, but also be confident and competent in their own ability to interpret and use SMBG data to teach problem-solving skills to their patients.

Information Provided by SMBG at Different Times of Day 1. Reprinted with permission from ref. Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest.

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Volume 26, Issue 2. Previous Article Next Article. Components of SMBG Education. Operational skills. Interpretive skills.

Article Navigation. From Research to Practice May 01 The Two Skill Sets of Self-Monitoring of Blood Glucose Education: The Operational and the Interpretive Mary M. Austin, MA, RD, CDE, FAADE Mary M. Austin, MA, RD, CDE, FAADE. This Site. Google Scholar.

Diabetes Spectr ;26 2 — Connected Content. A reference has been published: Self-Monitoring of Blood Glucose in Type 2 Diabetes : Preface. This is a reference to: Glucose Pattern Management Teaches Glycemia-Related Problem-Solving Skills in a Diabetes Self-Management Education Program.

Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. In Brief The usefulness of self-monitoring of blood glucose SMBG requires patients with diabetes to be competent and confident in their ability to carry out glucose testing and interpret its results to guide lifestyle choices and improve outcomes.

Table 1. View large. View Large. Table 2. Table 3. Code their meter if the device requires coding Perform a control-solution check with every new container of strips and more often if necessary if meter error is suspected because of unpredictable results. Use a meter that is clean and free of dried blood or debris Use an adequate-sized blood sample.

Use clean, dry fingers Using an alcohol swipe is not necessary. Table 4. Type of diabetes Willingness to perform SMBG Level of diabetes control Medication regimen Lifestyle and daily schedule with regard to activity, food, and work Physical ability to check blood glucose Ability to problem-solve and take action Financial limitations Comorbid conditions.

This glcose document describes studies Slow-releasing energy sources information that FDA recommends be used when submitting premarket notifications hlucose s for Self-monitoring blood glucose blood glucose Self-monitoringg systems SMBGs which are for over-the-counter OTC Nutrition myths unmasked use by vlood. This gluclse is not meant to glucoe blood glucose monitoring Self-monitorimg systems which are intended for prescription point-of-care use in professional healthcare settings e. FDA addresses those device types in another guidance entitled, "Blood Glucose Monitoring Test Systems for Prescription Point-of-Care Use" BGMS guidance. FDA is also issuing another BGMS guidance to reflect similar clarifications to the ones described in this guidance. You can submit online or written comments on any guidance at any time see 21 CFR Dockets Management Food and Drug Administration Fishers Lane, Rm Rockville, MD All written comments should be identified with this document's docket number: FDAD

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Glucsoe benefits of self-monitoring Self-monitoring blood glucose blood glucose Self-mohitoring on glycemic control among type 2 diabetes T2DM patients not receiving insulin remains controversial.

This study aimed to examine Self-monittoring association between SMBG and glycemic control in these patients. Self-momitoring retrospective longitudinal study enrolled eligible patients from a Self-nonitoring center in Taiwan. Data were Self-monitorkng from electronic medical records at 0 baseline3, 6, 9, Self-monotoring 12 end-point months after enrollment.

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Subgroup Self-minitoring for patients using non-insulin and insulin secretagogues were performed additionally. The estimated maximal gluccose in HbA1c reduction Sepf-monitoring groups early SMBG users vs. non-users was 0. Subgroup analyses showed maximal differences Self--monitoring 0.

SMBG group-by-time interaction was statistically significant at 3 months and lasted for 12 months. The finding gluxose that Selc-monitoring SMBG at disease onset was Self-momitoring associated blokd better glycemic Self-mobitoring in newly diagnosed non-insulin-treated Low glycemic grains patients, regardless Self-monitorong non-insulin secretagogues or insulin secretagogues were used.

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However, the benefits of Glucosd on glycemic control among those with type bkood diabetes Self-monltoring not receiving insulin has remained inconclusive 56 Swlf-monitoring, 7Self-mknitoring.

Therefore, the National Institute for Health Self-monitorihg Care Bllod guideline has yet to recommend Grape Vineyard Tours Bloor among patients with T2DM not on insulin unless specific Self-monitorng emerge Insulin pump training. By contrast, Self-monioring International Diabetes Federation IDF guideline suggests that SMBG should be considered at the time of diagnosis for non-insulin-treated patients with T2DM as Athlete bone health resources part of Metabolism booster for energy education to facilitate timely treatment Se,f-monitoring of the previous Sekf-monitoring on SMBG had Self-moniotring patients with various diabetes durations, with only a few focusing on patients newly diagnosed with T2DM.

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Glucoe, more Self-monitoringg from real-world data Self-jonitoring warranted to support its clinical effect. Furthermore, previous studies on Self-mojitoring did not analyze the effects resulting from different classes of anti-diabetic nlood.

Two broad Self-moitoring are of particular concern: insulin secretagogues insulin-releasing medications Wholesome eating patterns a potential adverse effect of hypoglycemia and non-insulin secretagogues that rarely cause hypoglycemia.

The current study aimed to examine the association between SMBG and glycemic control in newly diagnosed non-insulin-treated patients with T2DM and subgroups of patients receiving non-insulin and insulin secretagogues.

This retrospective cohort study was conducted at the Changhua Christian Hospital CCHTaiwan. A total of 24, patients with T2DM were screened for eligibility using registry data from the Diabetes Case Management Program DCMP at the CCH Diabetes Care Center between January and December The DCMP provides standardized comprehensive diabetes care including lifestyle assessment, physical examination, laboratory evaluation, and diabetes self-management DSM education such as instruction on nutrition, diet, exercise, medication, SMBG, and problem-solving skills aimed at reducing related complications.

All participants in the program received education during scheduled teaching sessions. Care is delivered by a coordinated multidisciplinary team, including physicians, and certified diabetes educators registered nurses and dietitians.

A detailed description of the program has been reported elsewhere Ultimately, eligible patients were identified for analysis Fig. Methods were performed in accordance with the relevant guidelines and regulations.

The Institutional Review Board of CCH granted the waiver for informed consent and approved the study IRB No: Flowchart of the study population. CCH, Changhua Christian Hospital; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; SMBG, self-monitoring of blood glucose.

Diabetes specialists referred patients with T2DM to the Diabetes Care Center to participate in the DCMP, usually 2 to 6 weeks after the first outpatient clinic visit. After enrollment into the DCMP, all patients were filed in the basic data registry; underwent health-related behavior survey, physical examination, and laboratory testing; and attended all of the standardized one-on-one diabetes self-management DSM education sessions.

Glycemic control was assessed using HbA1c level, which was regarded as a continuous variable for analysis. HbA1c levels were measured upon enrollment into the DCMP baseline values and at 3, 6, 9, and 12 months thereafter. Serum HbA1c was measured through ion-exchange high-performance liquid chromatography using the VARIANTTM II Turbo system.

SMBG was defined as self-assessment of blood glucose levels using a glucometer more than once per week. Participants were then categorized into early SMBG users and non-users groups based on availability of SMBG data at baseline. Insulin secretagogues included sulfonylureas and glinides, while non-insulin secretagogues included metformin, α-glucosidase inhibitor acarbosethiazolidinedione, and dipeptidyl peptidase 4 inhibitors.

Basic data included age at onset of diabetes, gender, education level, and family history of diabetes. Knowledge regarding glycemic control was defined as an understanding of the need for and methods of controlling blood glucose.

Willingness toward DSM was defined as the motivation to learn self-management techniques. Medication adherence was defined as taking medication regularly at the dose recommended by the physician over the past week. Four-point scales were used to assess the three aforementioned variables. Data were merged into simple dichotomies i.

bottom-two-box and categorized as adequate yes or inadequate no for analysis. Physical examination included measurement of blood pressure BPheight, and body weight. Systolic and diastolic BP were measured with the patients in a seated position after a min rest.

Baseline laboratory data included total cholesterol TChigh-density lipoprotein cholesterol HDL-Ctriglycerides TGlow-density lipoprotein cholesterol LDL-Ccreatinine, and glutamic pyruvic transaminase GPT levels measured using a UniCel DxC Synchron Clinical System Beckman Coulter, Brea, CA, USA.

eGFR was calculated using the equation recommended by the National Kidney Foundation Data on the 19 major non-psychiatric comorbidities described in the Charlson comorbidity index during the year preceding enrolment were collected from the CCH research database Major comorbidities, including congestive heart failure, coronary artery disease, and cerebrovascular accident, were analyzed as independent variables.

Differences among the four groups were assessed using the chi-square test for categorical variables and one-way analysis of variance for continuous variables. Generalized estimating equations GEE were used for the analysis of repeated HbA1c measurements outcome variable.

Statistical differences in HbA1c reduction between groups at each time-point were assessed using SMBG group-by-time interactions in GEE models established using the backward elimination method to select control variables.

Subgroup analyses were performed to evaluate the association between SMBG and glycemic control in subgroups receiving different types of anti-diabetic medications.

All analyses were two-tailed and conducted using IBM SPSS Statistics version 22 IBM Corp. A total of patients were identified average age, No significant differences were found in medication adherence, smoking, alcohol drinking, and BMI among the four groups.

Mean HbA1c reduction unadjusted from baseline to the end-point was 2. Table 3 shows the difference in HbA1c reduction between both groups at each time-point using GEE to adjust for significant baseline characteristics, including age, gender, education level, smoking, baseline HbA1c, BMI, blood lipids, SBP, Charlson comorbidity index, medication adherence, physical activity, and anti-diabetic medication use.

Variables included in the models were selected using the backward elimination method. Model-based estimated mean HbA1c values and longitudinal HbA1c trajectory after adjustment of other control variables are shown in Fig. Accordingly, both groups showed a decrease in HbA1c during the observation period.

Early SMBG users had a lower estimated HbA1c level than early SMBG non-users, with the maximal difference being 0. Details are presented in Supplementary Table S1. SMBG, self-monitoring of blood glucose; HbA1c, hemoglobin A1c. In the insulin secretagogue subgroup, early SMBG users and non-users had similar baseline estimated HbA1c levels 9.

Patients who performed early SMBG achieved greater HbA1c reduction than those who did not, with the maximal difference being 0. In the non-insulin secretagogue subgroup, early SMBG users had a much higher estimated baseline HbA1c than early SMBG non-users 8.

Nonetheless, the former had greater HbA1c reduction than the latter, with the maximal difference being 0. Basic characteristics of participants in each subgroup are shown in Supplementary Tables S2 to S5.

The details of GEE models in each subgroup are shown in Supplementary Tables S6 and S7. The latter group had significantly greater decrements in HbA1c reduction which reached a difference of 1. The current study found that SMBG was associated with better glycemic control in newly diagnosed non-insulin-treated patients with T2DM in a clinical practice setting.

The extra decrements in HbA1C reduction in early SMBG users compared with non-users were greater than 0. Most of the previous SMBG studies are RCTs that mainly included patients with various T2DM durations. Given the heterogenous baseline characteristics and SMBG-incorporated clinical interventions among such studies, the reported intervention effects of SMBG are inconsistent.

Some systematic reviews and meta-analyses showed differences in HbA1c reduction between groups approximately ranging from 0. Islet cell function, diabetes-related knowledge, attitudes, and self-management ability among newly diagnosed patients with diabetes differ from those who have experienced the disease longer.

Some studies suggested that newly diagnosed patients with T2DM are new to SMBG and would benefits more from SMBG than prevalent users 10 Nonetheless, others have suggested that newly diagnosed patients with T2DM might have improved glycemic control despite limited input from health care professionals Only a few studies have provided data regarding the effect of SMBG on glycemic control in newly diagnosed patients with T2DM.

showed a decrease of mean HbA1c levels after 12 months from 8. There were no significant differences between groups in HbA1c at any time- point. Whereas another RCT found that SMBG users had significant greater reduction in median HbA1c levels, from 6.

An observational study by Virdi et al.

: Self-monitoring blood glucose

Type 2 and Blood Glucose Checks

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Learn more. However, patients too often receive no formal SMBG training. The two skills sets required to successfully perform SMBG include 1 operating a glucose meter and 2 appropriately interpreting SMBG data.

Whenever diabetes education is provided, both skill sets, as well as potential barriers, should be assessed for all patients. Self-monitoring of blood glucose SMBG is an important aspect of treatment for all people with diabetes. It provides immediate feedback and data that enable people with diabetes to assess how their food choices, physical activity levels, and medications affect their blood glucose control.

SMBG results can aid people with diabetes in evaluating their current diabetes management efforts by either reinforcing or calling into question their lifestyle choices. The last American Diabetes Association ADA consensus conference on SMBG was held in More recently, other consensus panels have made recommendations related to SMBG use.

Although many health care professionals can teach the operational use of, and interpretive strategies for, SMBG, this article focuses on the role of diabetes educators in this process.

Potential Applications for SMBG Data 1. SMBG Recommendations for People With Noninsulin-Treated Type 2 Diabetes 5.

The goal of SMBG education is to ensure that people who use a blood glucose meter are competent and confident in their ability to perform blood glucose tests and interpret the resulting data to make lifestyle choices, which have an impact on clinical outcomes.

Competence and confidence are necessary for people to use SMBG effectively as a tool in their diabetes self-management plan. The two skill sets necessary for successful SMBG are 1 operational skills and 2 interpretive skills Table 3.

Because blood glucose meters can be obtained from a variety of sources, diabetes educators may not be directly involved initially in either teaching or assessing both of these skill sets.

At the time of diabetes education, regardless of how long ago a person was prescribed a blood glucose meter, it is important for diabetes educators to assess both of these skill sets to uncover potential barriers to using the meter and SMBG data. SMBG Education Checklist 1.

During education sessions in which the operational skills of monitoring are being taught, it is important that educators demonstrate the mechanics of performing a blood glucose test and then ask participants for a return demonstration. In addition to successfully performing blood glucose tests confidently and competently, individuals should learn how to use a lancet device, properly dispose of lancets and strips, use control solution, obtain an adequate blood sample, alternate testing sites, code the meter if required , clean the meter, and document their SMBG results in a logbook or download blood glucose data from the meter.

Educators should heed universal precautions when demonstrating how to operate a meter. Selecting a meter. Many factors should be considered when choosing an appropriate meter for an individual with diabetes.

These include patients' visual acuity, manual dexterity, and preferences, as well as meter size and readout options e. However, in many cases, meter selection is limited by patients' insurance coverage.

If there is a choice of covered meters, the educator should present the available options, and the selection should be based on individuals' needs and preferences.

It is important for educators to evaluate whether the meter itself is a barrier to SMBG for each patient. This may be the result when patients' insurance plan switches approved meters without patients receiving additional training or education. Unless such patients are comfortable and confident using the replacement meter, continued SMBG may be jeopardized.

The nuances of insurance coverage for meters and test strips can also become a barrier to SMBG. Educators should encourage their patients to contact their insurance plan and ask if the blood glucose meter and strips are considered a pharmacy benefit or a durable medical equipment benefit. It is not unusual for patients to go to a pharmacy to obtain their meter and strips only to be told that these items are not a covered benefit.

However, by asking the right questions of their insurers, patients sometimes find out that, although not covered under a pharmacy benefit, these items are covered if mail-ordered from a medical supply company.

Ensuring meter accuracy. The accuracy of the SMBG results depends on both meter capabilities and the human factor in performing a blood glucose test. The U. Food and Drug Administration requires all glucose meters to meet a minimum performance requirement set by the International Organization of Standardization ISO.

To ensure accurate data and limit human error when performing SMBG, educators should encourage individuals to:. Store their meter and strips properly Each meter has its own storage requirements; strips should be stored with cap on bottle and not exposed to light, moisture, or temperature variations.

Use strips that are compatible, defect-free, and not expired Expiration dates are not always provided when strips are supplied through a mail-order company.

Perform a control-solution check with every new container of strips and more often if necessary if meter error is suspected because of unpredictable results.

Control solution must be prescribed by a provider to be processed as a covered benefit. Use an adequate-sized blood sample. Educators may need to teach patients techniques for obtaining an adequate blood droplet, including how to select a lancing device and appropriate puncture depth.

Documenting SMBG data. It is essential for SMBG results to be available in a format that allows people with diabetes to assess the relationship between their blood glucose results and their food intake, physical activity, and medication regimen.

Meter memory features can be useful in verifying logbook accuracy, but used alone without a paper logbook may not provide patients with the opportunity to visualize multiple testing results over time. For patients who have downloadable meters and the capability and capacity to download their results usually displayed in various graphic formats , educators should review the downloading process to ensure that patients are interpreting the graphic displays correctly.

If it is also possible to transmit blood glucose results by phone or electronically, patients and providers or educators should come to an agreement about how often and when transmission should occur.

Patients should be encouraged to bring their meter and blood glucose documentation to every medical visit. This provides the opportunity to review results, clean the meter, verify meter codes if necessary, and perform a control-solution test.

Addressing individual needs. Certain populations have specific needs related to meter selection and use. The elderly, children, and the visually impaired may have unique SMBG needs. For the elderly, choice of meter and strips may be influenced by potential limitations in manual dexterity, slowed reaction time, or fluctuating vision.

It may be more convenient and cost-effective for the elderly to receive their supplies via mail-order. Children may benefit from meters that require a small sample of blood and lancing devices that hide the lancet and minimize discomfort.

Parents often appreciate features such as back lighting for the display, which makes testing in the middle of the night easier, and a memory capacity to store multiple results.

When children begin performing their own blood glucose checks, supervision should be provided to ensure that they are performing SMBG properly and recording results accurately. People with visual impairments would benefit from a meter that is small, is portable, provides a clear speech output, has tactile markings on strips, and offers a method for consistent placement of the blood sample.

A limited number of products offer these features. org for a list of currently available products. Interpreting SMBG results is considered a problem-solving self-care behavior. It is not uncommon for people who are testing their blood glucose, especially people with type 2 diabetes, to be proficient at and feel confident in their ability to perform tests, but to not use their SMBG data in lifestyle decision-making.

Additionally, if patients' HCPs do not use the SMBG data in clinical decision-making, then SMBG is of no value and a waste of resources.

ADA and AACE Target Blood Glucose Goals for Non-Pregnant Adults 10 , As an analogy, one may know how a parachute works and how to wear it properly, but unless one uses a parachute when jumping out of a plane, the parachute is of no value. The same can be said for SMBG: it provides value when the data obtained are used.

Using SMBG data depends on knowing blood glucose targets, understanding how often and when to test, and using glucose pattern management GPM in decision-making, not only for the people with diabetes, but also for their HCPs. Knowing blood glucose targets. ADA 11 and the American Association of Clinical Endocrinologists AACE 12 have set guidelines for blood glucose targets.

From a practical standpoint, it matters little which organization's blood glucose target guidelines are followed as long as patients who have been instructed to perform SMBG receive some blood glucose target recommendations.

HCPs have the responsibility to provide patients with blood glucose targets based on individual needs. ADA target blood glucose guidelines can be applicable to all people, given that tighter individual targets can be recommended that are within the ADA-recommended target range Table 4.

This range is helpful to individuals who find it difficult to check their blood glucose exactly 2 hours after the start of the meal.

HCPs should encourage individuals to write their targets in their blood glucose logbook or recording form; this helps to reinforce this information. Some meters with downloading capabilities can show results in a graphic format.

The blood glucose targets that are individually set on the meter should be clearly stated to the person using the meter and written down somewhere for reference when tests are performed. Knowing the appropriate frequency and timing of glucose tests. To minimize the pain associated with fingertip testing, the patient should rotate testing sites and test on the side of the third, fourth, or fifth finger as opposed to the pad of the finger.

In response to patient complaints, many glucometer manufacturers have calibrated devices to accurately detect blood glucose at alternative testing sites. Such sites include the forearm, upper arm, palm, thigh, calf, and base of the thumb.

A study compared glucose monitoring via traditional fingertip testing and forearm testing. Appropriate blood-collection technique is critical for an accurate blood glucose result. The testing site must be washed with soap and water or alcohol and dried, as food residue can skew the results.

To select an appropriate depth, the patient must apply the device firmly but without force to the testing site and keep the amount of pressure consistent. Previously, it was common practice to wipe away the first drop of blood after lancing the skin because the first drop contains a high amount of platelets, which could clot the sample during reading.

It is no longer necessary to do this because current blood glucose meters are fast enough to report results before clotting takes place. Continuous glucose monitoring CGM is another option for SMBG. With CGM, the patient wears a sensor that acts as a test strip.

Attached to the sensor is a transmitter that sends the glucose data to the receiver or reader. The receiver then tracks current and stored glucose readings. Interstitial glucose and blood glucose are not typically equal, and interstitial glucose values will lag behind blood glucose values.

The most common times to perform SMBG are during a fasting state, before a meal, 1 to 2 hours after a meal, and at bedtime. Some patients may need to test at less common times, such as before snacks, before or after exercise, and prior to performing critical tasks.

Some signs of hypoglycemia are shakiness, irritability, confusion, tachycardia, and hunger. Intensive Insulin Regimen: The patients requiring most frequent SMBG are those who are following an intensive insulin regimen. An intensive insulin regimen is defined as insulin pump therapy or multiple insulin injections per day.

The ADA recommends that these patients check blood glucose roughly six to 10 times per day at the following times: prior to meals and snacks, at bedtime, occasionally after meals, before exercise, when low blood glucose is suspected, after treating low blood glucose until normoglycemia is reached, and before critical tasks.

This patient population is most likely to benefit from using CGM to improve glycemic control, enhance quality of life, and minimize hypoglycemia. Basal Insulin With or Without Other Antidiabetic Agents: Patients taking basal insulin with or without other antidiabetic agents require significantly less intensive monitoring than patients on intensive insulin therapy.

In patients using basal insulin, evidence is insufficient regarding when and how often to perform SMBG. The AACE diabetes treatment guidelines include an algorithm to adjust basal insulin every 2 to 3 days based on fasting glucose readings in order to help the patient reach glycemic goals.

The researchers found no significant differences in glycemic control, quality of life, diabetes self-care activities, fasting blood glucose, or hypoglycemic events between the testing groups. No Insulin: The benefit of SMBG in patients not on insulin therapy is under much debate.

Neither the ADA nor the AACE can provide a recommendation as to when or how often a patient not taking insulin should test; however, both guidelines state that test results should be used to modify behavior or pharmacologic treatment in order to improve outcomes.

GPM is a systematic approach to finding glycemic patterns in the SMBG data and then taking appropriate action based on those results. Seeing the effects of diet and exercise on blood glucose can be a powerful motivator and reinforce successful behavior.

Diet: When glucose patterns are being established, it is crucial to monitor food intake. Because studies on the ideal amount of carbohydrates to consume are inconclusive, patients should monitor carbohydrate intake in relation to glucose response to determine individual patterns.

This is a prime example of how GPM in relation to dietary choices can be incorporated into a diabetes self-management plan. Exercise: Exercise uses glucose as a form of energy and will result in lower SMBG readings.

The ADA recommends minutes of moderate- to vigorous-intensity physical activity per week plus two to three sessions of resistance training per week. For example, a patient who identified a pattern of hypoglycemia after exercising now eats a small snack prior to exercise and avoids the hypoglycemic event.

This case illustrates how a patient was able to apply her glucose patterns to implement a self-care plan that caused her to remain within her blood glucose target. Patients commonly identify patterns of postprandial elevation. A recent study from China concluded that walking for 20 minutes after eating dinner can correct this pattern.

The study found a significantly lower 2-hour postprandial glucose spike, peak glucose, and average glucose in patients who walked compared to those who did not.

Pharmacists can guide patients in how to use glucometers correctly and to test using proper techniques to obtain accurate results.

They can also educate patients about important times to monitor their blood glucose, thus ensuring that the data obtained are useful for both the healthcare team and the self-management plan.

Finally, pharmacists can help patients identify glucose patterns and develop actions they can take in response to trends. Because pharmacists rank among the most trusted and ethical healthcare professionals, their contribution to diabetes education can help patients unlock the full potential of blood glucose monitoring.

Self-Monitoring of Blood Glucose in Patients With Non–Insulin-Dependent Diabetes Mellitus | AAFP Digital platforms that enable data analysis and secure data sharing, and foster education and motivation of PwD, help to streamline the workflow of HCPs and provide information to the payers in healthcare systems. Table 5. Nonetheless, some patients will naturally require more time than others to decide about de-escalation of self-monitoring, and the physician should expect to follow up and continue the conversation at future visits as needed. Poolsup N, Suksomboon N, Rattanasookchit S. This provides the opportunity to review results, clean the meter, verify meter codes if necessary, and perform a control-solution test. The two skill sets necessary for successful SMBG are 1 operational skills and 2 interpretive skills Table 3. Clinicians' attitudes to clinical practice guidelines: a systematic review.
Monitoring Your Blood Sugar

For example: Even if self-monitoring does prove to be unnecessary for many adults with type 2 diabetes not on insulin, might there still be people in this group who would benefit or circumstances that would require self-monitoring?

With all the things that people with diabetes need to do, self-monitoring might not be the best thing you could do with your time.

Instead, that time could be used for making other healthy behavior choices. Self-monitoring may be beneficial when done in a structured manner. Your doctor, in turn, uses your monitoring results to help guide your treatment plan. Research indicates that such monitoring can help people with type 2 diabetes whose blood glucose levels are well above their goals.

Researchers believe that blood glucose monitoring may prove helpful even in the short term, particularly for people who struggle to manage their levels. Structured self-monitoring of blood glucose can be useful to help people understand the impact of food and activity on their blood glucose levels and could be used for a short period as part of general diabetes education program.

And while other experts agree that structured monitoring can provide some benefits, they worry that it may require too much effort for too little benefit. Medical studies base their conclusions on evidence gathered from the large number of people who participate in them. Done well, they can help determine what does and does not benefit the average person.

They treat individuals with specific needs and circumstances. But monitoring can be essential for people who do take medications that can cause low blood glucose, such as meglitinides, sulfonylureas and insulin—and this is especially true for those who may not notice the symptoms of hypoglycemia in time to prevent such dangerous consequences as a car accident or coma.

Routine monitoring, including before getting behind the wheel, could prevent serious hypoglycemic events in people who use such meds. PwD experience a clear benefit by putting BG values into such a context and by adjusting their treatment to their glucose patterns.

In order to gain valuable information for therapy optimization, PwD do not only have to be educated adequately and their skills re-evaluated on a regular basis, but SMBG measurements and the associated diabetes management have to be carried out frequently, consistently, and in a structured manner [ 32 ].

To simplify the cumbersome requirements of diabetes management, modern SMBG systems usually offer several options for data download and analysis. Subsequently, the data can be analyzed with specialized software tools or digital mobile health apps. The results of this analysis can be used for diabetes management decisions.

Specialized software or apps can, for example, remind users of scheduled BG measurements or medication intake, keep a digital diary, mark high or low BG values, support the calculation of bolus insulin doses, or link BG values to the insulin doses delivered Table 2.

Reminders for scheduled BG measurements or medication intake can facilitate treatment adherence, which increases the benefit of SMBG in people with T2DM and subsequently counteracts existing clinical inertia [ 4 , 5 , 33 , 34 ]. An easy-to-use digital diary can support people with T2DM in discussions on their diabetes therapy with their HCPs.

For example, certain clinical events that do not coincide with daily lifestyle or diet, or even illness, can be recorded this way, thus enabling a comprehensive retrospective assessment. For those people with T2DM who use insulin, having the SMBG system connected to smart insulin pens allows a more complete picture of their therapeutic decisions in relation to the BG values measured with SMBG systems.

The obtained BG data can also be graphically analyzed and presented in reports, in the form of a pattern analysis Fig. In the example shown in Fig. Although this analysis only captures patterns obtained from SMBG measurements, and thus the patterns are highly dependent on the frequency and timing of the measurements, it allows clinicians and patients to make better informed therapeutic adjustments [ 36 ].

In addition, such reports may show other parameters and metrics, such as mean glucose concentration and the standard deviation SD , and they support the identification of glucose patterns. Not only are users supported in terms of optimizing their own therapy decisions, these reports also assist HCPs in assessing the success or failure of the diabetes therapy, including factors such as adherence and subsequent possible therapy adjustments.

An example of the latter is a change in medication, such as dosage change of anti-diabetic drugs, including insulin, or a complete change in therapy, such as a switch from a pure lifestyle intervention to a pharmacological intervention.

SMBG thus supports a closer collaboration between PwD and HCPs and should not be seen as a standalone intervention, but rather as part of a structured feedback loop; for example, an integrated personalized diabetes management shows a considerable improvement in the clinical outcome of insulin-dependent people with T2DM [ 37 ].

Last but not least, the opportunity to upload BG data to the Cloud does not only support data sharing and interaction with HCPs; a more in-depth analysis of these data with approaches using advanced algorithms and artificial intelligence will create additional insights of medical value [ 38 ].

Diabetes mellitus is a chronic disease affecting people around the world. However, new technologies and medications for diabetes therapy are often initially introduced in high-income countries, and PwD in other parts of the world often have to overcome hurdles regarding access to such diagnostic and therapeutic options.

This subject is discussed in the following sections. Among all countries for which data are available, China has the highest number of adults with diabetes, and it is anticipated that it will remain in this position until at least [ 1 ].

Applying the diagnostic criteria for diabetes suggested by the American Diabetes Association ADA , the data from two national representative epidemiological surveys in China showed that the prevalence of diabetes regardless of type went up from A guideline for SMBG was issued by the Chinese Diabetes Society in and updated 4 years later with the aim to enhance awareness and the standard of practice.

SMBG is recognized as an essential component of disease management by helping PwD to better understand their disease, controlling the disease status, and supporting HCPs in their treatment adjustments. Specific monitoring regimen and frequency of SMBG are recommended for subgroups of people with T2DM, including people on insulin and non-insulin glucose-lowering medications [ 41 ], applying the principle of structured SMBG monitoring.

It is recommended that the accuracy and precision of SMBG systems be in line with the latest version of the ISO standard. In , a draft version of the document was published with the aim to solicit public feedback.

The new national standard is anticipated to be in effect in the near future and will match the accuracy requirements of the international ISO standard.

Adherence to SMBG in people with T2DM is poor in China, even in those who are on insulin therapy. A nationwide survey of diabetes education, self-management, and glycemic control in people with T2D using the Summary of Diabetes Self-Care Activities scale showed that the lowest score was for BG testing and the highest scores was for medication, followed by diet [ 42 ].

Thus, the low implementation of structured SMBG is not only due to socio-economic factors, but also due to the lack of knowledge of PwD.

For example, a study involving people with T2DM in China showed that their self-efficacy could be improved by increasing their self-management knowledge through training and education [ 46 ]. In addition, such an educational approach, in combination with the advanced features of SMBG systems, which have been mentioned in previous sections, may provide a platform for HCP—patient interactions, enabling remote consultation and helping PwD to achieve their glycemic targets in a faster and sustainable way [ 47 ].

India is home to the second largest number of PwD in the world. According to the tenth edition of the Diabetes Atlas by the IDF, there were an estimated 74 million PwD in India in , and these numbers are set to increase to 92 million by and million by [ 1 ].

SMBG is recommended by various guidelines in India, including that of the Indian Council of Medical Research [ 49 ]. Further, the guidelines state that the frequency of SMBG should be individualized; for example, SMBG should occur at higher frequency during pregnancy of in other situations where tight glycemic control is indicated.

While no specifications are given in the guidelines about the accuracy of SMBG systems, it is implied that the standard international guidelines regarding the accuracy of SMBG systems are followed.

According to a study carried out by the SMBG International Working Group only 0. However, the frequency of SMBG remains low and grossly inadequate in India and lags behind that of other countries [ 51 ].

There are a number of possible explanations for this low use of SMBG in India. Around , with the introduction of low-cost SMBG systems, there was a surge in the purchase of SMBG systems in India; however, the cost of the test strips still remains high [ 52 ].

A lack of reimbursement for SMBG systems and test strips has also been a major deterrent to frequent SMBG testing in India [ 50 , 51 ]. Thus, the costs associated with SMBG systems both direct and indirect may explain partially their low use in India. Another possible explanation is that HCPs do not have the time to go through the laborious sheets of paper produced by PwD when they present their SMBG readings to them.

If the HCP does not show sufficient interest in the SMBG records, the individual gets disheartened and often stops performing SMBG altogether [ 54 ].

Another reason why SMBG has not taken off in India is that the PwD are not empowered to use the data to make adjustments to their diet, physical activity, and medication, either insulin or oral drugs, based on the SMBG readings obtained [ 51 ].

Additional reasons for the low use of SMBG may be the pain of obtaining a drop of capillary blood for SMBG, although lancets are getting better all the time and this should no longer be a deterrent, and a lack of medical insurance for outpatient or domiciliary diabetes care.

The chronic nature of diabetes mellitus means that lifelong BG testing is needed. Initially, each PwD is enthusiastic about checking BG levels. However, motivation generally drops over time and, with the exception of a few motivated people, PwD tend to give up and stop testing.

It should be noted that social media propagate fake news consisting of all kinds of myths and untruths about diabetes [ 55 ], thereby contribution to PwD not using SMBG devices.

For example, messages are frequently sent to the mobile phones of people stating that high BG levels are a normal, physiological reaction and treatment is not needed.

Some messages even state that there is no such thing as diabetes and that this disorder is a creation of physicians and the pharmaceutical industry to make money. There is also a large lobby against scientific and modern allopathic systems.

Practitioners of other 'alternative' health systems e. Many people are lured to these practitioners by these false promises and claims, with the result often being deterioration of their diabetes control. The solution to these problems is to increase awareness of the need for performing SMBG.

Even more importantly, people should be empowered about what action should be taken with their SMBG readings. This would help propagate SMBG in developing countries like India.

The prevalence of diabetes in Brazil varies greatly according to the region of the country, ranging from 5. Data from showed a mean diabetes prevalence of 7. An estimated In terms of number of PwD, this estimate positions the country in the sixth place globally and in first place in Latin America, with the vast majority of people living with T2DM.

This number is expected to grow in the next 20—30 years. Brazil is a continental size country whose population is characterized by great disparities and inequities; consequently, it is expected that major differences exist regarding diabetes control.

Indeed, a study involving PwD with data in the public healthcare system showed a mean duration of T2DM of The Brazilian Diabetes Society recommends SMBG in cases of T1DM, gestational diabetes mellitus, and insulin-treated T2DM. It also recommends SMBG in people with T2DM not on insulin when therapy is modified or in the presence of unstable glycemic control and risk of metabolic decompensation.

Sporadic monitoring after meals is also recommended for PwD using medications with prandial action. The Society emphasizes that the indication must be individualized [ 61 ]. In Brazil, the National Health System Sistema Único de Saúde is responsible for the distribution of medications, meters, test strips, and lancets.

Regarding monitoring, a federal law from sets out that all PwD are entitled to receive these materials free of charge as long as they are taking insulin as part of their treatment, together with enrollment in educational programs [ 62 ].

The reason to only distribute SMBG to insulin users was that, according to the regulators, there is no proven cost—benefit relation of SMBG to people with T2DM not using insulin. In addition to the distribution of materials to people with T2DM not using insulin being restricted, the use of SMBG is limited by the paucity of specialized HCPs to educate and train these people in ways that would ensure that SMBG would improve control.

PwD also showed some resistance to performing painful procedures. Another issue to consider is the number of capillary BG measurements needed to improve glycemic control. A regional study showed that the use of a restricted structured scheme of SMBG fasting, 3 times a week did not improve control in people with T2DM not treated with insulin, suggesting that a more intensive anti-diabetic approach would be necessary to obtain better results [ 65 ].

Some of these challenges could be solved through the establishment of programs on diabetes education. The importance of education was shown to be relevant in a Brazilian study in which training for self-titrating insulin doses was combined with structured SMBG. Improvement of glycemic control was found in poorly controlled people with T2DM on insulin therapy [ 66 ].

This strategy may facilitate effective insulin therapy in routine medical practice, compensating for any reluctance on the part of physicians to optimize insulin therapy and thus to improve the achievement of recommended targets of diabetes care.

Taking into account the aim to improve glycemic control of PwD in Brazil, in addition to prevention programs and new pharmacological approaches, better definitions of the importance of SMBG are needed. As one of the main components of diabetes care, national policies on SMBG should be more valued, with national studies evaluating characteristics of PwD, number of measurements, and structured glucose test profiles.

As everywhere else in the world, people in Brazil should have the opportunity to be trained on how to use SMBG devices and interpret the glucose values, and to undertake the appropriate action based on these values, as well as having their provision of supplies assured.

In the near future, technology and digital health approaches may offer new ways to turn monitoring diabetes into something more inexpensive and easier to use, enabling PwD worldwide to achieve better metabolic control. Performance of SMBG is and remains a cornerstone in the therapy of many people with diabetes.

As suggested by the reports on local experience from China, India, and Brazil, access to adequate SMBG can be limited by issues such as the high cost of SMBG systems, insufficient self-management education and empowerment, and, at least in some cases, cultural beliefs.

Issues such as these must be overcome on the way to optimal diabetes therapy. SMBG was established as a cornerstone of the therapy for PwD a few decades ago. Its benefit for PwD who are on insulin therapy, including people with T2DM on insulin therapy, is undisputed.

In people with T2DM not using insulin, effectiveness is linked to the active use of BG values for therapeutic decisions or therapy adjustments. SMBG systems have markedly evolved over time.

Not only have they become more accurate, modern SMBG systems offer several options for data connectivity and interoperability with diabetes management tools and devices, and thus simplify diabetes therapy notably.

However, reports of local experiences from three of the ten countries with the highest number of PwD in the world show that not all PwD have access to SMBG or other diagnostic and therapeutic options.

Major influences seem to be the high cost of SMBG systems as well as insufficient self-management education and empowerment. Removing these hurdles will not only lead to improved therapy for PwD and their resulting outcomes, but also to a higher quality of life.

Digital platforms that enable data analysis and secure data sharing, and foster education and motivation of PwD, help to streamline the workflow of HCPs and provide information to the payers in healthcare systems.

Smart phones are already the most prevalently used communication tool worldwide, and wirelessly connected SMBG systems can also empower PwD to make use of their personal SMBG results. Such developments will play a major role in achieving better glycemic control in PwD in highly and less developed regions of the world.

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Self-monitoring blood glucose

Author: Gardakree

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