Self Monitoring Blood Glucose Benefits All Patients with Diabetes

A panel of leading European diabetes experts led by Professor Oliver Schnell from the Diabetes Research Institute in Munich has published a "Consensus Statement: A European Perspective" on the benefits of self-monitoring of blood glucose values (SMBG). It recommends performing SMBG for all types of diabetes treatment approaches in order to achieve proper glucose control and values which are close to normal, without increasing the risk of hypoglycemia. It emphasizes that optimal frequency and patterns of SMBG always depend on a variety of factors including the type of diabetes, chosen therapy options, individually set targets of HbA1c as well as pre- and postprandial blood glucose values. "What is important to us is a homogeneous, structured and detailed approach to SMBG, which takes into account individual requirements," explains Professor Oliver Schnell. Blood glucose monitors can help to facilitate an individual's diabetes management, and offer different levels of personalization and features such as meal markers or post-meal reminders, which support patients especially with postprandial testing.

The expert group evaluated existing scientific information and agreed upon practical recommendations for different groups of diabetes patients with regard to timings, frequencies and target values for SMBG, which go beyond current national and international guidelines. In general, diabetologists recommend an overall target of 6.5 percent for the HbA1c value for most patients. According to the consensus group, this target should be modified based on individual patient needs: for women who are pregnant or are planning to have a baby, a value of less than 6 percent is recommended. Patients with a high risk of hypoglycemia or with unawareness of hypoglycemia should not get over 7 or 7.5 percent. Lower levels should be aimed for, but only if they can be achieved safely, since severe hypoglycemia should be avoided in all patients to reduce the risk of severe complications.

With regard to overall targets for preprandial blood glucose, a value of less than 6 mmol/L respectively 108 mg/dL is the average. This target may be modified for individual patients like children, "high-risk" patients with known coronary artery disease or severe hypoglycemia as well as pregnant women. The value for postprandial blood glucose should not exceed 7.8 mmol/L respectively 140 mg/dL. Here, testing is advised to be performed two hours after the meal and stressed as one of the key elements of optimal SMBG.

Also the recommended measuring frequency and timing depends on individual conditions such as the patient's treatment regimen. Experts differentiate between six patients' groups. Newly diagnosed Type 2 diabetics, for example, should test their blood glucose values three to five times a week to learn about the effects of lifestyle and medications on their metabolism. Instead, patients undergoing an intensified insulin treatment as well as "high risk" patients should check their values several times a day, especially postprandial or at nighttimes. For those experiencing severe hypoglycemia even an increased frequency of nocturnal testing is recommended.

As a general rule, the consensus paper states that individual glycemic targets should always be agreed upon between patient and the healthcare professional. Discussing the current results are advised to take place every three to six months, including pre and postprandial blood glucose values, HbA1c targets as well as lifestyle changes or circumstances complicating the effective control of diabetes, such as pregnancy, severe hypoglycemic episodes or altered medication orders. "Changes in any of these factors should trigger an immediate adaptation of target values to ensure optimal treatment outcome and avoid late complications", says Professor Schnell.

O. Schnell et al., Diabetes, Stoffwechsel und Herz, 2009, 4, 285-289