Value of self-monitoring blood glucose pattern analysis in improving diabetes outcomes

Abstract

Self-monitoring of blood glucose (SMBG) is an important adjunct to hemoglobin A1c (HbA1c) testing. This action can distinguish between fasting, preprandial, and postprandial hyperglycemia; detect glycemic excursions; identify and monitor resolution of hypoglycemia; and provide immediate feedback to patients about the effect of food choices, activity, and medication on glycemic control. Pattern analysis is a systematic approach to identifying glycemic patterns within SMBG data and then taking appropriate action based upon those results. The use of pattern analysis involves: (1) establishing pre- and postprandial glucose targets; (2) obtaining data on glucose levels, carbohydrate intake, medication administration (type, dosages, timing), activity levels and physical/emotional stress; (3) analyzing data to identify patterns of glycemic excursions, assessing any influential factors, and implementing appropriate action(s); and (4) performing ongoing SMBG to assess the impact of any therapeutic changes made. Computer-based and paper-based data collection and management tools can be developed to perform pattern analysis for identifying patterns in SMBG data. This approach to interpreting SMBG data facilitates rational therapeutic adjustments in response to this information. Pattern analysis of SMBG data can be of equal or greater value than measurement of HbA1c levels.

Figure 1.

Day graph (modal day) from electronic data management tool. The graph provides detailed information on the blood glucose values and helps define the degree of glucose exposure and glucose variability over the reported time period. The blue boxes represent the standard deviation on mean blood glucose values, reflecting the glycemic variability.

Figure 2.

Accu-Chek^® 360° View blood glucose analysis system. The form is used to create a seven-point glucose profile over 3 days.Space is provided to plot and visualize blood glucose results. Guidelines on the form (rows highlighted in yellow) indicate pre- or postprandial blood glucose target ranges and ranges considered too high or low. Additional space is provided at the bottom to allow individuals to document what they learned from their testing.