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This article originally posted and appeared in  BG ControlType 1 DiabetesInsulinGlucose MonitoringIssue 681

Frequency of Blood Glucose Testing in Type 1's: How Often is Enough?

"Good diabetes control can be achieved in routine diabetes care with flexible intensified insulin therapy based on continuing patient education."...
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As we know, self-monitored blood glucose (SMBG), as well as the knowledge of proper insulin use and requirements, is essential for proper metabolic control in patients with diabetes mellitus type 1. However, the question that this study tries to answer in particular is, what frequency of self monitoring of blood glucose is considered necessary for the most favorable glycemic control? 

This study focused especially on well-educated patients who understand the daily management of diabetes type 1 and the specific insulin requirements given. How often and to what extent SMBG should be executed on a daily basis remains unclear.

The study design used patients with type 1 diabetes and implemented a flexible and intensified insulin therapy. Intensive or flexible therapy involves using a constant supply of insulin to serve as the basalinsulin as well as providing mealtime insulin in doses relative to the nutritional load of the meals. Supplying extra insulin was also allowed when glucose levels were exceedingly high and in need of proper correction. These three components of the insulin regimen are commonly referred to as basal insulin, bolus insulin, and high glucose correction insulin methods.

Researchers evaluated HbA1c values and the directly preceding computerized SMBG-frequencies over a 12 month period. To approximate the relationship between HbA1c and SMBG-frequency the researchers used a fitted piecewise linear spline model with a change in slope at 4 SMBGs per day. The authors of the study recommended a minimal self monitoring blood glucose frequency of 4 times a day for best results.

The final study included a total of 150 patients who underwent the SMBG and HbA1c analysis. The study population used in the study had a median baseline HbA1c of 7.1% (interquartile range 6.6, 7.8). The final statistical assessment included a multivariable analysis which adjusted for gender and psychological problems. It was finally concluded that each added self monitoring blood glucose measurement by each patient was associated with an estimated difference in HbA1c of −0.19% (95% confidence interval (CI) −0.42, 0.05) for ≤4 SMBGs per day and of −0.02% (95% CI −0.10, 0.06) for >4 SMBGs per day.

What this statistical analysis ultimately illustrated was that optimal metabolic control was possible for diabetic type 1 patients with routine diabetes care, flexible and intensified insulin therapy coupled with continuing patient education and a minimum of 4 SMBGs checks per day.

A.Minder, D. Albrecht, J. Schäfer, and et al. "Frequency of blood glucose testing in well-educated patients with diabetes mellitus type 1: How often is enough?" Division of Endocrinology Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.. Elsevier Ireland Ltd, 31 May 2013. Web. 4 Jun 2013.

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This article originally posted 13 June, 2013 and appeared in  BG ControlType 1 DiabetesInsulinGlucose MonitoringIssue 681

Past five issues: Diabetes Clinical Mastery Series Issue 208 | Issue 748 | GLP-1 Special Editions September 2014 | Diabetes Clinical Mastery Series Issue 207 | Issue 747 |

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