Page 24 - Glucose Monitoring Devices

The shortcomings of SMBG and future perspective 19

Table 1.1 Current clinical guidelines and consensus statements for self-monitoring
of blood glucose in type 2 diabetes.dcont’d
Guideline Recommendations
• BGM in patients on basal insulin þ1 daily
prandial or premixed insulin injection: at
minimum when fasting and before the prandial
or premixed insulin, and periodically at other
times (i.e., premeal, bedtime, 3 a.m.).
• Additional testing before exercise or critical
tasks (e.g., driving) as needed.
Type 2dLow risk of hypoglycemia
• Daily BGM not recommended.
• Initial periodic structured BGM (e.g., at meals
and bedtime) may be useful in helping patients
understand the effectiveness of MNT/lifestyle
therapy.
• Once at the A1C goal, less frequent monitoring
is acceptable.
A1C, glycated hemoglobin; BGM, blood glucose monitoring; CMG, continuous glucose monitoring;
DVLA, Driver and Vehicle Licensing Agency; HbA1c, glycated hemoglobin; MDI, multiple daily in-
jections; MNT, medical nutrition therapy; SMBG, self-monitoring of blood glucose.
a
American Diabetes Association. 7. Diabetes Technology: Standards of Medical Care in Diabetes
(2019).
b
Management of hyperglycemia in type 2 diabetes: ADA-EASD Consensus Report (2018).
c
International Diabetes Federation. Global guideline for type 2 diabetes (2012).
d
International Diabetes Federation. Self-monitoring of blood glucose in noninsulin-treated type 2
diabetes (2009).
e
National Institute for Health and Care Excellence. Type 2 diabetes in adults: management (2015).
f
Diabetes UK, Position statement: Self-monitoring of blood glucose levels for adults with Type 2
diabetes (2017).
g
American Association of Clinical Endocrinologists and American College of Endocrinology. Outpatient
Glucose Monitoring Consensus Statement (2016).
The shortcomings of SMBG and future perspective
Studies indicate that a substantial proportion of individuals with both T1D and T2D
does not perform SMBG at recommended frequencies. In a large cohort study of
24,312 adults with diabetes, SMBG adherence rates with ADA recommendations
were reported to be as low as 34% for T1D, 54% for insulin-treated T2D and
20% for noninsulin-treated T2D [49]. Similarly, a youth analysis of uploaded data
from insulin pumps demonstrated only a 31% adherence rate to the recommendation
to enter four or more SMBG readings per day [108]. Data form the T1D Exchange
Registry showed that 34% of participants performed SMBG less than four times per
day [109]. Moreover, recently updated data demonstrated that 41% of 13,344 partic-
ipants not using a continuous glucose monitor performed SMBG zero to three times
per day [110]. In Sweden, where glucose meters and strips are being generally
available at no cost, less than 50% of adults with T1D perform SMBG four times