Page 19 - Glucose Monitoring Devices

14 CHAPTER 1 Introduction to SMBG

Structured SMBG has been shown to effectively reduce HbA1c levels in noninsulin-
treated individuals with suboptimal initial glycemic control [79]. To enhance
standardized approaches to SMBG in noninsulin-treated T2D, a European expert
panel has recommended on length and frequency of SMBG performance depending
on clinical circumstances and quality of glycemic control by using two SMBG
schemes (a less intensive and an intensive). In an intensive seven-point SMBG
regimen, SMBG is performed before and after each meal and at bedtime. In a less
intensive SMBG regimen testing blood glucose before and after meals is performed
for alternating meals over the course of a week. After obtaining sufficient glucose
profiles, the frequency of SMBG should be reevaluated and timing and frequency
of monitoring further individualized because in stable and good glucose control
infrequent monitoring may be needed [107]. Current guidelines and consensus
statements on the SMBG in persons with T2D are outlined in Table 1.1.

Table 1.1 Current clinical guidelines and consensus statements for self-
monitoring of blood glucose in type 2 diabetes.
Guideline Recommendations
American Diabetes Association a • Most patients using intensive insulin regimens
(multiple daily injections or insulin pump
therapy) should assess glucose levels using
self-monitoring of blood glucose (or continuous
glucose monitoring) before meals and snacks,
at bedtime, occasionally postprandially, before
exercise, when they suspect low blood
glucose, after treating low blood glucose until
they are normoglycemic, and before critical
tasks such as driving.
• When prescribed as part of a broad
educational program, self-monitoring of blood
glucose may help to guide treatment decisions
and/or self-management for patients taking
less frequent insulin injections.
• When prescribing self-monitoring of blood
glucose, ensure that patients receive ongoing
instruction and regular evaluation of technique,
results, and their ability to use data from self-
monitoring of blood glucose to adjust therapy.
Similarly, continuous glucose monitoring use
requires robust and ongoing diabetes educa-
tion, training, and support.
• The evidence is insufficient regarding when to
prescribe SMBG and how often testing is
needed for insulin-treated patients who do not
use intensive insulin regimens, such as those
with type 2 diabetes using basal insulin with or
without oral agents.