What are the recommendations for checking home blood sugar levels in type 2 diabetes?

From the Guidelines

For type 2 diabetes, routine use of blood glucose monitoring is not recommended for people treated with diet and/or oral agents alone, but frequent monitoring is recommended for those using intensive insulin regimens or insulin pump therapy. The optimal frequency of glucose monitoring for individuals with type 2 diabetes is not known, but it should be sufficient to facilitate reaching goals of glycemic control 1. Blood sugar monitoring recommendations vary based on individual treatment plans, but generally include checking levels 1-2 times daily for those on insulin or sulfonylureas, and less frequently for those managing with lifestyle or other medications. Most patients should check fasting blood glucose in the morning and occasionally after meals to understand how food affects their levels. The target range is typically 80-130 mg/dL before meals and less than 180 mg/dL two hours after meals, though these targets may be adjusted based on age, health conditions, and hypoglycemia risk. Patients should record their readings in a logbook or app, noting factors that might affect results like food, activity, illness, or stress. More frequent monitoring is recommended during illness, medication changes, or when experiencing symptoms of high or low blood sugar. Regular monitoring helps patients understand how medications, food, and activity affect their glucose levels, allowing for timely adjustments to maintain control and prevent complications. The specific monitoring schedule should be personalized with your healthcare provider based on your treatment plan and individual needs.

Some key points to consider:

• The frequency and timing of glucose monitoring should be dictated by the needs and goals of the individual patient 1.
• Intensive glycemic control can decrease microvascular complications, and frequent blood glucose monitoring is recommended for all people with diabetes who use intensive insulin regimens 1.
• The role of blood glucose monitoring in stable diet-treated patients with type 2 diabetes is not known, and routine use of blood glucose monitoring is not recommended for people with type 2 diabetes treated with diet and/or oral agents alone 1.
• Patients using insulin, particularly those with type 1 diabetes, use knowledge of ambient capillary or interstitial glucose concentrations as an aid in determining basal insulin requirements and in selecting appropriate insulin doses for meals and at different times of the day 1.

It's essential to note that the evidence is based on the most recent and highest quality study available, which is from 2023 1. This study provides the most up-to-date recommendations for blood glucose monitoring in type 2 diabetes.

From the FDA Drug Label

Patients should be informed that frequent, patient-performed blood glucose measurements are needed to achieve effective glycemic control to avoid both hyperglycemia and hypoglycemia

• The FDA drug label recommends frequent blood glucose measurements for patients with type 2 diabetes.
• The label does not specify the exact frequency of blood glucose measurements.
• It is implied that the frequency of measurements should be determined on an individual basis to achieve effective glycemic control 2.

From the Research

Recommendations for Checking Home Blood Sugar Levels in Type 2 Diabetes

The frequency and timing of self-monitoring of blood glucose (SMBG) in type 2 diabetes are crucial for achieving optimal glycemic control. Here are some key points to consider:

• The Canadian Diabetes Association recommends SMBG for patients with type 2 diabetes, particularly for those using insulin 3.
• A global consensus conference of diabetes experts emphasized the importance of SMBG in optimizing glycemic control, detecting postprandial excursions, and identifying glucose patterns 4.
• The frequency of SMBG should be individualized based on the patient's type of diabetes, treatment regimen, and clinical characteristics 5.
• Studies have shown that SMBG can be effective in improving glycemic control, with a moderate but significant reduction in HbA1c levels (~0.5% reduction) compared to usual care 3.
• However, the quality of evidence is generally low, and more robust trials are needed to clarify the effect of SMBG on glycemic control in type 2 diabetes 3.

Factors to Consider When Checking Home Blood Sugar Levels

Some factors to consider when checking home blood sugar levels include:

• The patient's treatment regimen, such as insulin or oral agents 5.
• The patient's clinical characteristics, such as the presence of hypoglycemia or hyperglycemia 5.
• The patient's ability to perform SMBG and interpret the results 4.
• The availability of continuous glucose monitoring (CGM) technology, which can provide more detailed information on glucose levels and trends 6.

Best Practices for Checking Home Blood Sugar Levels

Best practices for checking home blood sugar levels include:

• Performing SMBG at least once per day, and more frequently if necessary, to detect asymptomatic hypoglycemia and guide patient behavior 7.
• Using SMBG data to adjust treatment regimens and lifestyle modifications to achieve optimal glycemic control 4.
• Considering the use of CGM technology to provide more detailed information on glucose levels and trends 6.
• Ensuring that patients are educated on how to perform SMBG and interpret the results, and that they have access to healthcare professionals for guidance and support 4.