From the Guidelines
The frequency and timing of self-monitoring of blood glucose (SMBG) should be individualized and dictated by the particular needs and goals of the patient, with a focus on preventing hypoglycemia and adjusting medications, medical nutrition therapy (MNT), and physical activity. When reviewing FSBG readings, it is essential to consider the patient's specific requirements, such as the type of diabetes, treatment regimen, and presence of hypoglycemia unawareness or frequent hypoglycemic episodes 1. For patients with type 1 diabetes and pregnant women taking insulin, SMBG is recommended three or more times daily, while for those with type 2 diabetes on noninsulin therapy, the optimal frequency and timing of SMBG are unclear 1.
Key Considerations for SMBG
- The accuracy of SMBG is instrument and user-dependent, and patients should be taught how to use the data to adjust food intake, exercise, or pharmacological therapy to achieve specific glycemic goals 1.
- Real-time continuous glucose monitoring (CGM) may be a supplemental tool to SMBG in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes, and can provide alarms for hypo- and hyperglycemic excursions 1.
- The frequency and timing of SMBG should be reevaluated at each visit to avoid overuse, particularly if SMBG is not being used effectively for self-management 1.
Clinical Implications
- Increased daily frequency of SMBG has been associated with lower A1C levels and fewer acute complications in patients with type 1 diabetes 1.
- In patients with type 2 diabetes who are not using insulin, potential benefits of glucose monitoring include insight into the effects of diet, physical activity, and medication management, as well as assessing hypoglycemia and glucose levels during intercurrent illness 1.
- Healthcare providers should be aware of medications and other factors that can interfere with glucose meter accuracy and choose appropriate devices for their patients 1.
From the Research
FSBG Readings Review
- The accuracy of continuous glucose monitoring system (CGMS) and finger-stick blood glucose (FSBG) was assessed in patients with type 2 diabetes during daily activities and exercise sessions, showing that agreement between FSBG and CGMS becomes weaker during exercise, but more than 90% of the CGMS readings are within acceptable range 2.
- A study evaluated the compliance of hourly blood glucose monitoring and relation of less frequent blood glucose monitoring to glycemic status in patients receiving insulin infusion, finding that the risk of hypoglycemic episodes was not significantly different with less frequent blood glucose monitoring 3.
- Self-monitoring of blood glucose (SMBG) was found to reduce HbA1c in non-insulin-treated participants with type 2 diabetes, particularly when SMBG readings were used to adjust therapy 4.
- The combination of GLP-1 receptor agonist and SGLT2 inhibitor was shown to be effective in reducing HbA1c and cardiovascular events, with potential additive benefits on metabolic-cardiovascular-renal disease in patients with type 2 diabetes mellitus 5.
Key Findings
- FSBG readings are accurate, but their accuracy may decrease during exercise 2.
- Less frequent blood glucose monitoring may not increase the risk of hypoglycemic episodes in patients receiving insulin infusion 3.
- SMBG can improve HbA1c in non-insulin-treated participants with type 2 diabetes, especially when used to adjust therapy 4.
- Combination therapy with GLP-1 receptor agonist and SGLT2 inhibitor may provide additive benefits on cardiovascular and renal outcomes 5.
Implications
- Clinicians should consider the potential benefits and limitations of FSBG readings in patients with type 2 diabetes 2, 3.
- Structured self-monitoring of blood glucose regimens may be more effective in improving HbA1c than unstructured regimens 4.
- Combination therapy with GLP-1 receptor agonist and SGLT2 inhibitor may be a useful treatment option for patients with type 2 diabetes mellitus 5.