Self-Monitoring of Blood Glucose (SMBG)

Intuition suggests that the more often people with diabetes check their blood sugars, the better their glycemic control will be. Frequent and careful blood glucose monitoring is unquestionably useful for people who take insulin, but is monitoring necessary for all patients? The American Association of Diabetes Educators (AADE) says: “yes.” Last winter the AADE published a position statement in The Diabetes Educator supporting the use of self-monitoring of blood glucose (SMBG) by all persons with diabetes, even the most ‘stable’ type 2 patients.

The introduction of blood glucose meters revolutionized diabetes care by empowering patients to manage their own disease, but sadly the technology is still widely underused. The AADE acknowledges the controversy about whether SMBG actually improves outcomes like A1c and diabetic complications in type 2 patients, but they recommend it for all diabetes patients despite this.

Without regular monitoring and therapeutic adjustments, glycemic control tends to worsen over time for type 2 diabetes patients – this is why type 2 is sometimes called a ‘progressive’ disease. In addition, SMBG provides data to evaluate the impact of lifestyle changes, events like exercise and meals, and other common occurrences such as illness, on glycemia. It also helps guide the adjustment of diabetic medications. SMBG encourages more active patient involvement, which leads to better outcomes.

We think this AADE statement is yet another reminder of the need in diabetes for more short-term investments in education in return for long-term payoffs in outcomes. The AADE advocates extensive education for preventive behaviors in people with diabetes. We agree, but unfortunately, diabetes education remains difficult to obtain and even more difficult to get reimbursed, which is why patients need to be as proactive as possible with doctors, nurses, and any other healthcare professionals.

The bottom line: Self-monitoring of blood glucose is recommended for all patients with diabetes, both type 1 and type 2. Short-term investments in diabetes education can make a big difference in long-term payoffs of better outcomes and fewer complications.

(Austin M. “AADE Position Statement: Self-Monitoring of Blood Glucose: Benefits and Utilization.” The Diabetes Educator. Nov/Dec 2006. 32: 835-847.)