Self-Monitoring of Blood Glucose as an Integral Part in the Management of People with Type 2 Diabetes Mellitus

Abstract

For decades, self-monitoring of blood glucose (SMBG) has been considered a cornerstone of adequate diabetes management. Structured SMBG can follow different monitoring patterns, and it results in improved glycemic control, reduced hypoglycemia, and a better quality of life of people with diabetes. The technology, usability, and accuracy of SMBG systems have advanced markedly since their introduction a few decades ago. Current SMBG systems are small and easy to use, require small (capillary) blood sample volumes, and provide measurement results within seconds. In addition, devices are increasingly equipped with features such as connectivity to other devices and/or digital diaries and diabetes management tools. Although measurement quality can come close to or equal that of the glucose monitoring systems used by healthcare professionals, several available SMBG systems still do not meet internationally accepted accuracy standards, such as the International Organization for Standardization 15197 standard. Reports from China, India, and Brazil based on local experience suggest that in addition of the accuracy issues of SMBG systems, other obstacles also need to be overcome to optimize SMBG usage. Nonetheless, adequate usage of SMBG data is of high relevance for the management of people with type 2 diabetes mellitus.

Keywords: Accuracy; Blood glucose monitoring systems; Diabetes management; Self-monitoring of blood glucose; Type 2 diabetes mellitus.

Fig. 1

a Example of a structured glucose testing profile (7-point profile) using a system for self-monitoring of blood glucose (SMBG). SMBG results were entered manually into the ACCU-CHEK® 360° View Paper tool (Roche Diabetes Care GmbH, Mannheim, Germany), showing postprandial hyperglycemia. The forms for mmol/L and mg/dL can be downloaded from the Electronic Supplementary Material of this article. b Example of a glucose pattern analysis using an SMBG system. The figure shows the same glucose testing profile as in a, but data of the SMBG system were transferred to the RocheDiabetes Care Platform and visualized. RocheDiabetes, ACCU-CHEK and ACCU-CHEK 360° are trademarks of Roche

Fig. 2

a Difference plot showing methods comparisons for two systems for SMBG with higher (green squares) and lower (red triangles) levels of accuracy. The orange lines reflect the accuracy requirements of the current ISO 15197:2015 standard [21], i.e., 95% of measurements need to fall within up to ± 0.8 mmol/L (± 15 mg/dL) or ± 15% from the comparison method (for values < 5.6 mmol/L [< 100 mg/dL] or ≥ 5.6 mmol/L [≥ 100 mg/dL]). b Scatter plot of SMBG systems with higher (green squares) and lower (red triangles) levels of accuracy