Results that matter: Structured vs. unstructured self-monitoring of blood glucose in type 2 diabetes

http://www.diabetesresearchclinicalpractice.com/article/S0168-8227(12)00098-8/fulltext#abstract

Abstract 

Self-monitoring of blood glucose (SMBG) is one component of diabetes management. SMBG presents information about current glycemic status and provides the ability to obtain immediate feedback regarding the impact of behavioral and pharmacological interventions on glucose levels. However, SMBG is useful only when the glucose information is understood correctly, data are accurately interpreted, and results prompt appropriate therapeutic actions.

The International Diabetes Federation (IDF) recently published guidelines for SMBG use in non-insulin treated people with diabetes, recommending that SMBG should be used only when patients and/or their clinicians possess the ability and willingness to incorporate SMBG monitoring and therapy adjustment into their diabetes care plan. If SMBG is used, the IDF also recommends that structured SMBG be performed utilizing defined regimens to meet individual needs.

Structured SMBG can be performed as daily glucose profiles that are representative of daily glucose excursions. Measuring preprandial/postprandial blood glucose (bG) levels on consecutive or alternating days (“testing in pairs”) also provides impactful glucose information for daily diabetes management.

This article reviews recent studies that appropriately utilized structured SMBG as an integral component of comprehensive diabetes management and discusses how their findings support the IDF recommendations. Our goal is to help clinicians make more informed decisions about the value and utility of SMBG in diabetes management.

COMMENT: The role of SMBG in type 2 diabetes especially in persons who do not take nsulin is cotroversial.  Data are not information.  If patients faithfully monitor their glucose, but neither the patients nor their physicians use the data to make changes in their regimens, then it is a waste of time and money.  This article reviews the effectiveness of SMBG when the data are used in a structured manner.  While one might argue that the authors are biased because of their connections with Roche Diagnostics, the data speak for themselves.  The data reviewed suggest that SMBG is a useful adjunct to the care of persons with type 2 diabetes when used to adjust therapy in a structured manner.