Page 18 - Glucose Monitoring Devices

Guidelines for SMBG 13

close to normal. All women with diabetes need to monitor fasting and postprandial
blood glucose levels daily. The frequency of monitoring will increase up to 10 times
per day for women with T1D and women with T2D on an intensive insulin regimen,
who should also test blood glucose preprandially [94,95].
Due to the insufficient evidence, the ADA guidelines do not recommend when to
prescribe SMBG and at what frequency the testing is needed in persons with T2D
using basal insulin with or without oral agents; thus the optimal regimen is not clear
[92]. Nevertheless, in persons with T2D on basal insulin therapy, assessing fasting
plasma glucose with SMBG enables insulin dose titration to reach glycemic targets
in the absence of hypoglycemia [96,97]. In the Reduction with an Initial Glargine
Intervention (ORIGIN) trial, fasting capillary glucose levels were recorded daily
until target values were achieved, and then at least twice per week [98].
SMBG in noninsulin-treated T2D helps to educate people about their condition,
allows them to monitor the impact of food, physical activity, lifestyle choices, and
medications on blood glucose levels, empowers self-management, and guides
healthcare professionals to adjust therapeutic regimens. However, the clinical
efficacy of SMBG in noninsulin-treated T2D has varied between studies. This em-
phasizes the challenge to understand the true benefit of SMBG in noninsulin-treated
T2D and warrants further well-designed randomized controlled trials and longitudi-
nal observational studies. ADA guidelines recommend SMBG use combined with
education and support as a guide to successful therapy for some people with T2D
not using insulin, and leave options open for individualized care [92,99]. Diabetes
UK, similarly, recommends a targeted approach to SMBG use in noninsulin-
treated individuals with T2D, based on the individual assessment of need [100].
The National Institute for Health and Care Excellence, however, advises against
daily glucose testing in adults with T2D, unless the person is on insulin, is pregnant
or is at risk of hypoglycemic episodes [101]. Some guidelines recommend SMBG in
persons whose regimens include sulfonylurea due to the higher risk of hypoglycemia
[96,102,103]. The International Diabetes Federation (IDF) recommends using struc-
tured SMBG, where patients and healthcare providers have the knowledge, skills,
and willingness to incorporate SMBG and therapy adjustments into diabetes care
plans [104]. Considering postmeal plasma glucose as a key predictor of cardiovas-
cular events and all-cause mortality, the IDF recommends to evaluate postprandial
glucose levels, as a key component to improve glycemic control regardless of insulin
treatment prescription [105]. As the relative contribution of postprandial hypergly-
cemia to HbA1c levels is greater at HbA1c levels that are closer to 7% [106],
postprandial testing should be considered for achieving HbA1c under 7% [101].
The American Association of Clinical Endocrinologists and the American College
of Endocrinology (AACE/ACE) states that people with diabetes should be given
advice regarding when and how frequently to monitor their blood glucose. Health-
care providers should review recorded SMBG data in a logbook or downloaded to
the personal computer to make appropriate therapeutic adjustments if glycemic
control is not at goal [96]. To optimize treatment, structured SMBG schedules,
which enable to identify daily glycemic patterns have been proposed [104].