The new ADA blood glucose self-monitoring recommendations do not prescribe how many tests should be done but rather focus on the individual situations in which testing should occur….
For patients with type 1 or type 2 diabetes who take multiple daily doses of insulin or are on pump therapy, the previous recommendation had been that these patients perform blood glucose self-monitoring "three or more times daily." Some payers had interpreted that to mean that three tests a day was sufficient for all patients, Dr. Richard Grant (Kaiser Permanente Division of Research, Oakland, CA), incoming chair of the ADA Professional Practice Committee, noted.
The 2013 ADA advice for patients on intensive insulin therapy is for testing at least before meals, occasionally after eating, at bedtime, before exercise or critical tasks such as driving, when low blood glucose is suspected, and after treating low blood glucose to ensure normoglycemia has been reached.
"We’re trying to say it’s very situation-dependent . . . both by the patient and the patient’s context," he said.
In contrast, for patients with type 2 diabetes who take basal insulin or noninsulin diabetes treatments, blood glucose self-monitoring is still recommended as being potentially helpful to guide treatment decisions "when prescribed as part of a broader educational context," but only when patients are educated about how to make use of the results.
In general, Grant said, for patients not taking insulin, blood glucose self-monitoring "is really not any use if it’s not being acted on. . . . If no one looks at the results, there’s no sense testing."
With regard to the removal of the three-times-daily number, Dr. Yehuda Handelsman (Metabolic Institute of America, Tarzana, CA) expressed concern that insurers might actually interpret that as endorsing less frequent testing for patients who use insulin.
How messages are conveyed matters, he said. "It’s about how you define the goals and where you put the emphasis."
According to Grant, the new document was the ADA’s best attempt to balance the evidence from the literature with the needs of the individual patient. "Evidence-based guidelines apply to populations of patients with diabetes, but we really need to tailor these population-level recommendations to the individual in front of us."
Clinical Practice Recommendations, Diabetes Care Supplement Jan 2013