UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Self-monitoring of blood glucose in management of adults with diabetes mellitus

Author
David K McCulloch, MD
Section Editor
Irl B Hirsch, MD
Deputy Editor
Jean E Mulder, MD

INTRODUCTION

All patients with diabetes mellitus who use insulin and some patients who take other glucose-lowering medications that can cause hypoglycemia should measure their blood glucose concentrations to help maintain safe, target-driven glucose control. The effectiveness of self-monitoring in patients with type 2 diabetes who do not use hypoglycemic agents is less certain.

In addition to self-monitoring of blood glucose (SMBG), periodic measurement of glycated hemoglobin (A1C) is the accepted means of estimating chronic glycemic control. Several practical points about SMBG will be reviewed here, including the accuracy of glucose meters and glucose test strips, the accuracy of the operator, the efficacy and reliability of continuous glucose monitoring (CGM) systems, and how to use the glucose information that is obtained. The use of A1C measurements to estimate mean blood glucose is reviewed elsewhere. (See "Estimation of blood glucose control in diabetes mellitus".)

SELF-MONITORING OF BLOOD GLUCOSE

Self-monitoring of blood glucose (SMBG) usually requires intermittent capillary blood sampling and the use of a glucose meter, with different frequencies of testing indicated for type 1 and type 2 diabetes. Devices to sample the glucose continuously from interstitial fluid are also available, with ongoing development in progress. Most continuous glucose monitoring (CGM) devices still require some SMBG testing for calibration and to double-check high and low CGM values. (See 'Continuous glucose monitoring' below.)

Indications — Based upon the results of randomized trials, we suggest SMBG in patients who take medications that can cause hypoglycemia and that need to be adjusted based on ambient glucose levels.

Type 1 diabetes — SMBG is an integral part of intensive therapy aimed at achieving near-normal glycemia in type 1 diabetes, which is widely accepted as recommended therapy owing to its benefits. Ideally, testing at home should be done four to seven times daily (before and 90 to 120 minutes after meals, before bedtime, and, occasionally for safety, at 3 AM). Additionally, it is useful to test blood glucose levels before, during, and after exercise. Patients with hypoglycemia unawareness may need to test more frequently, particularly prior to driving or operating any machinery, watching small children, and other activities where compromise of cognitive function may be dangerous.

                  
To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 17, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. American Diabetes Association. 6. Glycemic Targets. Diabetes Care 2017; 40:S48.
  2. Coster S, Gulliford MC, Seed PT, et al. Self-monitoring in Type 2 diabetes mellitus: a meta-analysis. Diabet Med 2000; 17:755.
  3. Welschen LM, Bloemendal E, Nijpels G, et al. Self-monitoring of blood glucose in patients with type 2 diabetes who are not using insulin: a systematic review. Diabetes Care 2005; 28:1510.
  4. Poolsup N, Suksomboon N, Rattanasookchit S. Meta-analysis of the benefits of self-monitoring of blood glucose on glycemic control in type 2 diabetes patients: an update. Diabetes Technol Ther 2009; 11:775.
  5. Malanda UL, Welschen LM, 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 2012; 1:CD005060.
  6. Farmer AJ, Perera R, Ward A, et al. Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. BMJ 2012; 344:e486.
  7. Clar C, Barnard K, Cummins E, et al. Self-monitoring of blood glucose in type 2 diabetes: systematic review. Health Technol Assess 2010; 14:1.
  8. 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 2017; 177:920.
  9. O'Kane MJ, Bunting B, Copeland M, et al. Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial. BMJ 2008; 336:1174.
  10. Saudek CD, Derr RL, Kalyani RR. Assessing glycemia in diabetes using self-monitoring blood glucose and hemoglobin A1c. JAMA 2006; 295:1688.
  11. Goldstein DE, Little RR, Lorenz RA, et al. Tests of glycemia in diabetes. Diabetes Care 2004; 27:1761.
  12. Farmer A, Wade A, Goyder E, et al. Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial. BMJ 2007; 335:132.
  13. Simon J, Gray A, Clarke P, et al. Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial. BMJ 2008; 336:1177.
  14. Freckmann G, Baumstark A, Jendrike N, et al. System accuracy evaluation of 27 blood glucose monitoring systems according to DIN EN ISO 15197. Diabetes Technol Ther 2010; 12:221.
  15. Kuo CY, Hsu CT, Ho CS, et al. Accuracy and precision evaluation of seven self-monitoring blood glucose systems. Diabetes Technol Ther 2011; 13:596.
  16. Trajanoski Z, Brunner GA, Gfrerer RJ, et al. Accuracy of home blood glucose meters during hypoglycemia. Diabetes Care 1996; 19:1412.
  17. Brunner GA, Ellmerer M, Sendlhofer G, et al. Validation of home blood glucose meters with respect to clinical and analytical approaches. Diabetes Care 1998; 21:585.
  18. Desachy A, Vuagnat AC, Ghazali AD, et al. Accuracy of bedside glucometry in critically ill patients: influence of clinical characteristics and perfusion index. Mayo Clin Proc 2008; 83:400.
  19. Fineberg SE, Bergenstal RM, Bernstein RM, et al. Use of an automated device for alternative site blood glucose monitoring. Diabetes Care 2001; 24:1217.
  20. Ellison JM, Stegmann JM, Colner SL, et al. Rapid changes in postprandial blood glucose produce concentration differences at finger, forearm, and thigh sampling sites. Diabetes Care 2002; 25:961.
  21. Jungheim K, Koschinsky T. Glucose monitoring at the arm: risky delays of hypoglycemia and hyperglycemia detection. Diabetes Care 2002; 25:956.
  22. Lewandrowski K, Cheek R, Nathan DM, et al. Implementation of capillary blood glucose monitoring in a teaching hospital and determination of program requirements to maintain quality testing. Am J Med 1992; 93:419.
  23. Sacks DB, Bruns DE, Goldstein DE, et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem 2002; 48:436.
  24. Klonoff DC. Continuous glucose monitoring: roadmap for 21st century diabetes therapy. Diabetes Care 2005; 28:1231.
  25. Hirsch IB. Clinical review: Realistic expectations and practical use of continuous glucose monitoring for the endocrinologist. J Clin Endocrinol Metab 2009; 94:2232.
  26. Ritholz MD, Atakov-Castillo A, Beste M, et al. Psychosocial factors associated with use of continuous glucose monitoring. Diabet Med 2010; 27:1060.
  27. Klonoff DC, Buckingham B, Christiansen JS, et al. Continuous glucose monitoring: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2011; 96:2968.
  28. Garg S, Zisser H, Schwartz S, et al. Improvement in glycemic excursions with a transcutaneous, real-time continuous glucose sensor: a randomized controlled trial. Diabetes Care 2006; 29:44.
  29. Monsod TP, Flanagan DE, Rife F, et al. Do sensor glucose levels accurately predict plasma glucose concentrations during hypoglycemia and hyperinsulinemia? Diabetes Care 2002; 25:889.
  30. Edelman SV. Regulation Catches Up to Reality. J Diabetes Sci Technol 2017; 11:160.
  31. Castle JR, Jacobs PG. Nonadjunctive Use of Continuous Glucose Monitoring for Diabetes Treatment Decisions. J Diabetes Sci Technol 2016; 10:1169.
  32. Aleppo G, Ruedy KJ, Riddlesworth TD, et al. REPLACE-BG: A Randomized Trial Comparing Continuous Glucose Monitoring With and Without Routine Blood Glucose Monitoring in Adults With Well-Controlled Type 1 Diabetes. Diabetes Care 2017; 40:538.
  33. Bolinder J, Antuna R, Geelhoed-Duijvestijn P, et al. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet 2016; 388:2254.
  34. Heinemann L, Freckmann G. CGM Versus FGM; or, Continuous Glucose Monitoring Is Not Flash Glucose Monitoring. J Diabetes Sci Technol 2015; 9:947.
  35. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm431385.htm (Accessed on January 29, 2015).
  36. Pickup JC, Freeman SC, Sutton AJ. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data. BMJ 2011; 343:d3805.
  37. Gandhi GY, Kovalaske M, Kudva Y, et al. Efficacy of continuous glucose monitoring in improving glycemic control and reducing hypoglycemia: a systematic review and meta-analysis of randomized trials. J Diabetes Sci Technol 2011; 5:952.
  38. Langendam M, Luijf YM, Hooft L, et al. Continuous glucose monitoring systems for type 1 diabetes mellitus. Cochrane Database Syst Rev 2012; 1:CD008101.
  39. Szypowska A, Ramotowska A, Dzygalo K, Golicki D. Beneficial effect of real-time continuous glucose monitoring system on glycemic control in type 1 diabetic patients: systematic review and meta-analysis of randomized trials. Eur J Endocrinol 2012; 166:567.
  40. Yeh HC, Brown TT, Maruthur N, et al. Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. Ann Intern Med 2012; 157:336.
  41. Beck RW, Riddlesworth T, Ruedy K, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial. JAMA 2017; 317:371.
  42. Lind M, Polonsky W, Hirsch IB, et al. Continuous Glucose Monitoring vs Conventional Therapy for Glycemic Control in Adults With Type 1 Diabetes Treated With Multiple Daily Insulin Injections: The GOLD Randomized Clinical Trial. JAMA 2017; 317:379.
  43. Beck RW, Riddlesworth TD, Ruedy K, et al. Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections: A Randomized Trial. Ann Intern Med 2017; 167:365.
  44. Mastrototaro J, Shin J, Marcus A, et al. The accuracy and efficacy of real-time continuous glucose monitoring sensor in patients with type 1 diabetes. Diabetes Technol Ther 2008; 10:385.
  45. Castle JR, Pitts A, Hanavan K, et al. The accuracy benefit of multiple amperometric glucose sensors in people with type 1 diabetes. Diabetes Care 2012; 35:706.
  46. Damiano ER, El-Khatib FH, Zheng H, et al. A comparative effectiveness analysis of three continuous glucose monitors. Diabetes Care 2013; 36:251.
  47. Damiano ER, McKeon K, El-Khatib FH, et al. A comparative effectiveness analysis of three continuous glucose monitors: the Navigator, G4 Platinum, and Enlite. J Diabetes Sci Technol 2014; 8:699.
  48. Matuleviciene V, Joseph JI, Andelin M, et al. A clinical trial of the accuracy and treatment experience of the Dexcom G4 sensor (Dexcom G4 system) and Enlite sensor (guardian REAL-time system) tested simultaneously in ambulatory patients with type 1 diabetes. Diabetes Technol Ther 2014; 16:759.
  49. Maahs DM, DeSalvo D, Pyle L, et al. Effect of acetaminophen on CGM glucose in an outpatient setting. Diabetes Care 2015; 38:e158.
  50. Peel E, Douglas M, Lawton J. Self monitoring of blood glucose in type 2 diabetes: longitudinal qualitative study of patients' perspectives. BMJ 2007; 335:493.
  51. Polonsky WH, Fisher L, Schikman CH, et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study. Diabetes Care 2011; 34:262.
  52. Bektas F, Eray O, Sari R, Akbas H. Point of care blood ketone testing of diabetic patients in the emergency department. Endocr Res 2004; 30:395.
  53. American Diabetes Association. Urine glucose and ketone determinations. Diabetes Care 1995; 18 Suppl 1:20.