Is home surveillance of diabetes considered good practice?

Home Surveillance of Diabetes: Evidence-Based Recommendations

Home monitoring of blood glucose is strongly recommended for diabetes management as it helps improve glycemic control, prevent complications, and enhance quality of life when coupled with proper education and follow-up. 1

Effectiveness of Home Monitoring by Patient Population

Patients on Intensive Insulin Regimens

• Self-monitoring of blood glucose (SMBG) is essential for insulin-treated patients to monitor and prevent hypoglycemia and hyperglycemia 1
• Recommended monitoring times: before meals and snacks, at bedtime, prior to exercise, when hypoglycemia is suspected, after treating low blood glucose until normoglycemic, and before critical tasks like driving 1
• For many patients on intensive insulin regimens, this may require checking 6-10 times daily, though individual needs vary 1

Patients Using Basal Insulin and/or Oral Agents

• For patients using basal insulin, assessing fasting glucose with SMBG to inform dose adjustments helps achieve lower A1C levels 1
• Evidence is insufficient regarding optimal frequency of testing for insulin-treated patients not on intensive regimens 1

Patients on Non-insulin Therapies

• Routine glucose monitoring may provide limited additional clinical benefit for people with type 2 diabetes not using insulin 1
• However, monitoring can be helpful when altering diet, physical activity, or medications (especially those that can cause hypoglycemia) when coupled with a treatment adjustment program 1

Technology Selection and Implementation

Device Selection

• Technology use should be individualized based on patient's needs, desires, skill level, and device availability 1
• Only FDA-approved meters with proven accuracy should be used, with unexpired strips purchased from a pharmacy or licensed distributor 1
• Providers should be aware of medications and other factors (e.g., high-dose vitamin C, hypoxemia) that can interfere with glucose meter accuracy 1

Patient Education Requirements

• When prescribing SMBG, ensure patients receive ongoing instruction and regular evaluation of:
  • Technique
  • Results interpretation
  • Ability to use data to adjust therapy
  • Uploading/sharing data when applicable 1
• Patients should be educated on proper use and disposal of monitoring equipment 1

Advanced Monitoring Technologies

Continuous Glucose Monitoring (CGM)

• CGM provides frequent measurements of interstitial glucose levels and information on direction/magnitude of glucose trends 1, 2
• Benefits include improved safety and effectiveness of diabetes therapy, reduced hypoglycemia incidence/duration, and decreased glycemic variability 2
• While CGM has theoretical advantages over point-of-care glucose testing in detecting hypoglycemia, it has not been FDA-approved for inpatient use 1

Home Temperature Monitoring

• For patients at moderate or high risk of foot ulceration, daily self-monitoring of foot skin temperatures can help identify early signs of inflammation 1
• If temperature difference between corresponding regions of left and right foot exceeds 2.2°C (4.0°F) on two consecutive days, patients should reduce activity and consult a healthcare professional 1

Effectiveness of Home Monitoring Programs

Impact on Clinical Outcomes

• Digital diabetes programs using home monitoring are associated with significant improvements in glycemic control and other diabetes measures 3
• Virtual health interventions using connected devices show wide acceptance across diverse populations 3
• Home monitoring, when coupled with education and follow-up, can improve the lives and health of people with diabetes 1

Potential Limitations

• Home monitoring of urine or blood glucose is widely practiced in Type 2 diabetes at considerable expense, but evidence of its value in improving blood glucose control or preventing complications may be limited for some patient populations 4
• For non-insulin treated patients, the benefits of routine monitoring may be less clear 1

Implementation Considerations

Practical Recommendations

• Blood pressure should be monitored at home by all hypertensive patients with diabetes 1
• Patients should have access to appropriate equipment, medications, supplies, and prescriptions at discharge from hospital care to avoid dangerous gaps in monitoring 1
• Remote patient monitoring can be facilitated through telehealth, digital applications, and connected devices 5

Common Pitfalls to Avoid

• Using only sliding scale insulin regimens in hospital settings is strongly discouraged 1
• Many patients monitor but don't keep written records (78%) or don't alter treatment based on results (62%) 4
• Failure to provide proper education on interpretation of results can limit the effectiveness of home monitoring 4

Home monitoring technology is rapidly evolving, with expanded options including hybrid devices that both monitor glucose and deliver insulin, as well as supportive software applications 1. While the complexity of the diabetes technology landscape can be a barrier to implementation, proper education and follow-up support can maximize the benefits of home surveillance for diabetes management 1.