Self-Monitoring of Blood Glucose

Treatment

In combination with lifestyle measures (weight control, proper nutrition, and adequate exercise), treatments such as self-monitoring of blood glucose (SMBG) are recommended approaches to improving glycemic control in patients with diabetes mellitus.

Need for Recommendations

Despite widespread use, the benefits of SMBG — especially in patients with type 2 diabetes not using insulin — and the optimum frequency of testing has not been defined. Further, costs associated with SMBG are high and rising steadily due to the increasing prevalence of diabetes in Canada and higher rates of self-monitoring.

One of the Canadian Agency for Drugs and Technologies in Health’s (CADTH’s) former advisory committees, the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) Advisory Committee (representing Canadian health jurisdictions), recommended that we review the clinical and economic evidence relating to the optimal prescribing and use of SMBG. Key research questions included:

• What is the optimal blood glucose testing frequency in patients with type 2 diabetes mellitus?
• What is the optimal blood glucose testing frequency in patients with type 1 diabetes mellitus and in patients with gestational diabetes mellitus?

Key Messages

CADTH’s work on this project has resulted in the following key messages:

• For people with type 1 or type 2 diabetes using basal-bolus insulin regimens, SMBG should be individualized to guide adjustments in insulin therapy.
• In adults with type 2 diabetes using basal insulin, SMBG should be individualized, but testing of up to 14 times per week should suffice in most cases.
• Most adults with type 2 diabetes using oral antidiabetes drugs (without insulin) do not require routine SMBG. Period testing may be needed for select patients, such as those with:
  
  
  • unstable glucose levels
  • acute illness
  • changes to drug therapy
  • risk of hypoglycemia
  • pregnancy
  • jobs where hypoglycemia poses danger.

Periodic testing in these select patients should be linked to specific actions (e.g., prevention or management of hypoglycemia, self-directed dosage adjustment).

• Most adults with type 2 diabetes controlled by diet alone should not require routine SMBG.

Refer to our Project Status web page to find out what stage we are at in this project.

Related Information:

• Background on Self-Monitoring of Blood Glucose (Report and Findings-at-a-Glance)
• Media Contacts and Key Links
• Frequently Asked Questions