Self-Monitoring of Blood Glucose—An Overview

Diabetes Technology & TherapeuticsVol. 15, No. S1 Original ArticlesFree AccessSelf-Monitoring of Blood Glucose—An OverviewSatish K. Garg and Irl B. HirschSatish K. GargBarbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Aurora, COSearch for more papers by this author and Irl B. HirschUniversity of Washington Medical Center, Seattle, WASearch for more papers by this authorPublished Online:26 Feb 2013https://doi.org/10.1089/dia.2013.1501AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail IntroductionGlobally, diabetes prevalence continues to increase, and now the International Diabetes Federation estimates that by the year 2030 there will be more than half a billion people affected by the disease. Better diabetes management that improves glucose control must include new technology implementations in day-to-day care, e.g., self-monitoring of blood glucose (SMBG), continuous glucose monitoring (CGM), and other devices such as those discussed throughout this yearbook. Recent data indicates a downward trend in all diabetes complications, especially in patients with type 1 diabetes.According to international standards, all glucose meters on the market for patient use must adhere to the following guidelines: ≥95% of blood glucose (BG) results should fall within +/−15 mg/dL of the reference method at BG concentrations <75 mg/dL, and within +/−20% at BG concentrations ≥75 mg/dL. However, a 2010 study found that 11 out of 27 meters did not meet these requirements (PMID 20151773). In March 2010, the U.S. Food and Drug Administration/Center for Devices and Radiological Health (FDA/CDRH) held a public meeting to discuss the accuracy of available BG meters. In the future, we might see tighter standards for accuracy of all meters. To provide one example of how real-world factors can affect meter accuracy, a study comparing BG measurements from first-drop blood samples obtained under various states of hand cleanliness found that 11% of participants had a ≥10% difference in BG concentrations, depending on whether their hands were washed or unwashed. In washed versus fruit-exposed hands, the ≥10% difference occurred in 88% of participants (PMID 21289231). These researchers recommended that if hand washing is not possible, and the patient's hands are not visibly soiled or in recent contact with sugar-containing foods, the patient should wipe away the first drop of blood and use a second drop for the test in order to improve accuracy.In spite of the potential for inaccurate glucose measurements, SMBG testing is clearly associated with improved A1C levels in patients with type 1 diabetes (T1DM) and insulin-treated type 2 diabetes (T2DM) (PMID 20377657; 20307405). Patients who do not require insulin may also benefit from SMBG; however, the debate in this area continues. This in part is due to the rising cost, and payers want to reduce their cost and thus the reimbursements. We reviewed more than 380 monitoring systems (MS) and found the following, representing the current debate specifically around new cost, telemedicine, and use of mobile technologies.Cost of self-monitoring of blood glucose in Canada among patients on insulin regimen for diabetesYeaw J1, Lee WC2, Wolden ML3, Christensen T3, Groleau D41IMS Consulting Group, Redwood City, CA; 2IMS Consulting Group, Alexandria, VA; 3Novo Nordisk A/S, Søborg, Denmark; and 4Novo Nordisk Canada Inc. Mississauga, ON, CanadaDiabetes Ther 2012; 3: 7IntroductionPeople with diabetes are at increased risk for a variety of medical conditions compared to individuals without diabetes, resulting in increased healthcare costs. Self-monitoring of blood glucose (SMBG) is recommended for effective diabetes self-management. However, little is known about the real-world frequency and actual expenditures associated with SMBG or about the impact of SMBG costs relative to the cost of diabetes treatments. The primary aim of this study is to determine the real-world utilization and costs of SMBG tests in Canada among individuals with insulin-treated diabetes during a 12-month follow-up period.MethodsThis retrospective cohort study utilized the IMS Brogan Inc. Drug Plan database from July 1, 2006, through June 30, 2010. During the 12-month follow-up period, the total cost assessment included blood glucose (BG) test strips, insulin therapy, and costs associated with oral antidiabetic medications. The analytical sample included patients who had two or more prescriptions for insulin between January 1, 2007, and December 31, 2009, with the first prescription serving as a patient's index date. Each patient was categorized into one of four insulin regimen groups depending on the type of insulin used, whether basal, bolus, premix, or basal–bolus.ResultsThe sample population of patients with two or more claims for insulin between January 1, 2007, and December 31, 2009, totaled 142,551. The overall mean utilization of pharmacy-based blood glucose testing materials was approximately 1,094 strips per person per year, with an average cost per test strip of Canadian $0.79. Therefore, the SMBG treatment costs for insulin users ($860), specifically those associated with prescription blood glucose test strips, totaled 41.6% of the average annual pharmacy costs of diabetes-related prescriptions ($2,068).ConclusionThis study shows that SMBG accounts for slightly more than 40% of the total diabetes-related pharmacy costs for insulin users.Cost of self-monitoring of blood glucose in the United States among patients on an insulin regimen for diabetesYeaw J1, Lee WC2, Aagren M3, Christensen T 41Economics and Outcomes Research, IMS Consulting Group, Redwood City, CA; 2IMS Consulting Group, Alexandria, VA; 3Novo Nordisk, Virum, Denmark; and 4Novo Nordisk, Copenhagen, DenmarkJ Manag Care Pharm 2012;18: 21–32BackgroundPeople with diabetes are at an increased risk of developing numerous complications, resulting in increased healthcare expenditures, economic burden, and higher mortality. Self-monitoring of blood glucose (SMBG) is a core component of effective diabetes self-management for patients using an insulin pump or multiple insulin injections. There is little data available to assess the real-world frequency and true costs associated with SMBG as a percentage of the total costs of an insulin regimen for patients in the United States.ObjectiveThe purpose of this study was to evaluate SMBG frequency, SMBG-related costs (including blood glucose test strips and testing supplies), and insulin therapy costs for patients with diabetes who use insulin and had at least one pharmacy claim for blood glucose test strips during a 12-month follow-up period.MethodsRetrospective data capture was conducted using the IMS LifeLink Health Plan Claims database. Data analysis focused on the frequency and costs associated with SMBG in relation to a specific insulin regimen, and SMBG expenditure was compared with other treatment costs. The patient cohort studied had two or more claims for insulin between January 1, 2007, and June 30, 2009, with the first claim determining the index date for that patient. Insulin-related costs were evaluated for the same 12-month follow-up period.ResultsOf the initial sample of 373,946 patients with at least two claims for insulin between January 1, 2007, and June 30, 2009, a final cohort of 45,555 patients (12.2%) met the inclusion and exclusion criteria. SMBG-related pharmacy costs accounted for 27% of the total insulin- and SMBG-related treatment costs for insulin users. The average cost per patient for prescription test strips and supplies was $772 compared to $2,078 for insulin prescriptions and supplies. The overall mean utilization of pharmacy-based SMBG test strips was 764.3 strips per year, and the average cost per test strip was $0.98. When utilization costs were subcategorized by insulin type, the annual SMBG costs for total insulin and SMBG-related pharmacy costs were 24.5% for the basal insulin group, 35.8% for bolus, 21.0% for premixed, and 26.4% for basal-bolus.ConclusionFor insulin users with at least one pharmacy claim for glucose test strips, SMBG-related costs accounted for about 25% of total insulin and SMBG-related pharmacy costs.CommentThese two studies highlight the significant cost related to SMBG (of the average annual pharmacy costs of diabetes-related pharmacy costs) in Canada and the United States, even in insulin-treated patients. Could there be generic strips that could significantly reduce the ever-increasing cost? With the increasing costs of insulin and all related supplies, assessing the actual costs of SMBG testing as a proportion of all pharmacy costs is a new and possibly important new metric to follow over time.The role of blood glucose monitoring in non-insulin-treated type 2 diabetes: What is the evidence?Benhalima K, Mathieu CDepartment of Diabetes & Endocrinology, UZ Gasthuisberg, Catholic University of Leuven, BelgiumPrim Care Diabetes 2012;6: 179–85Self-monitoring of blood glucose (SMBG) has increasingly been recognized as a core component of effective diabetes self-management among patients with insulin-treated type 2 diabetes (T2DM) over the past few decades. The worldwide prevalence of T2DM continues to increase rapidly, and management of T2DM can be costly. It is critical to determine whether resources devoted to SMBG in patients with non-insulin-treated T2DM are also justified and being used effectively. We review the conflicting evidence on the use of SMBG in patients with insulin-naive T2DM.Glycemic control in Iranian children with type 1 diabetes mellitus: effect of genderSetoodeh A, Mostafavi F, Hedayat TDepartment of Endocrinology, Children's Hospital Medical Center, Tehran, University of Medical Sciences, Tehran, IranIndian J Pediatr. 2012 Jul;79(7):896–900. doi: 10.1007/s12098-011-0613-8. Epub 2011 Dec 3.ObjectivesThe purpose of this study was to assess the effect of gender on glycemic control, diabetic complications, and associated abnormalities in patients with type 1 diabetes mellitus (T1DM).MethodsThis cross-sectional study included patients with T1DM that were referred to an endocrinology clinic in a children's hospital in Tehran from March 2005 through March 2007. Each patient completed a questionnaire, and the effect of gender on glycemic control was evaluated.ResultsThe data indicated that male patients performed self-monitoring of blood glucose significantly more often than female patients. The mean HbA1c, used as an indicator of glycemic control, as well as other relevant measures, including insulin dose per kg of body weight, frequency of diabetic ketoacidosis (DKA), height problems, and dyslipidemia were significantly higher in female patients.ConclusionsThis evidence of worse glycemic control and higher incidence of DKA, dyslipidemia, and height problems in female patients suggests the need for a greater emphasis on glycemic control in female patients with T1DM, according to local clinical management guidelines.CommentThis report is disturbing to note that, in the 21st century, we are still talking about gender differences in the care of diabetes. The authors noted higher incidence of DKA, hyperlipidemia, and height problems related to poor glycemic control in women.Performance of a new blood glucose monitoring system in the hands of intended usersBailey TS1, Wallace JF2, Parkes JL2, Pardo S2, Yu J2, Schachner HC2, Simmons DA2, Chu A21AMCR Institute Inc., Escondido, CA; and 2Bayer Health Care LLC, Diabetes Care, Tarrytown, NYDiabetes Technol Ther 2012; 14: 783–89BackgroundThis study evaluated the performance of a blood glucose monitoring system (BGMS) in development that uses a new generation of blood glucose test strips to measure blood glucose levels in capillary and venous blood. The new BGMS was assessed in the hands of its intended users, people with diabetes, and healthcare professionals (HCPs).Subject and MethodsThe study population included 93 subjects ≥18 years old (median age 33 years) with either type 1 (78%) or type 2 (22%) diabetes. Untrained subjects performed self-test fingersticks using a Microlet®2 lancing device (Bayer HealthCare LLC, Diabetes Care, Tarrytown, NY) followed by testing of their own capillary blood on the BGMS. HCPs performed fingersticks using a Tenderlett® lancing device (International Technidyne Corp., Edison, NJ) and venipunctures on subjects, and used the BGMS to test both the capillary and venous samples. All BGMS results were compared with laboratory results obtained on a Yellow Springs Instruments analyzer (YSI Life Sciences, Inc., Yellow Springs, OH). Analytical accuracy was assessed according to International Organization for Standardization (ISO) 15197:2003 guidelines (i.e., within ±15 mg/dL or ±20% of the YSI results for samples with glucose concentrations <75 mg/dL and =75 mg/dL, respectively) and more stringent criteria (i.e., within±15 mg/dL or ±15% of the YSI results for samples with glucose concentrations <100 mg/dL and =100 mg/dL, respectively).ResultsOverall, 98.9% (180/182) of the self-test fingerstick capillary blood results using the Microlet2 capillary fingerstick results, 99.5% (182/183) of the HCP Tenderlett capillary fingerstick results, and 100% (186/186) of the venous results met current ISO criteria and more stringent criteria. The average hematocrit was 44%; values ranged from 32% to 52%.ConclusionsBlood glucose measurements from both capillary fingerstick and venous samples obtained using a new BGMS in development met current accuracy guidelines as well as proposed tighter criteria.The impact of self-monitoring of blood glucose on a behavioral weight loss intervention for patients with type 2 diabetesMcAndrew LM1,2, Napolitano MA3, Pogach LM2,4, Quigley KS5, Shantz KL6, Vander Veur SS6, Foster GD61Department of Veterans Affairs, New Jersey Health Care System, War Related Illness and Injury Study Center, East Orange, NJ; 2The University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ; 3Temple University, Department of Kinesiology and Public Health, ND Center for Obesity Research and Education, Philadelphia, PA; 4Department of Veteran Affairs, New Jersey Healthcare System, Center for Healthcare Knowledge Management, East Orange, NJ; 5The Center for Health Quality, Outcomes, Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, and the Department of Psychology, Northeastern University, Boston, MA; and 6Temple University, Center for Obesity Research and Education, Philadelphia, PADiabetes Educ 2012; Jun 26. [Epub ahead of print]PurposeThis study was intended to evaluate the association between self-monitoring of blood glucose (SMBG) and weight loss and A1C among participants in a behavioral weight loss intervention.MethodsThe relationship between SMBG and changes in patient weight and A1C levels was evaluated using multivariate analysis. Bootstrapping was used to determine whether there was an indirect effect of SMBG on weight loss through diet adherence and an indirect effect of SMBG on A1C through weight loss.ResultsThe relationship between increased SMBG and greater weight loss was mediated by better adherence to diet. Similarly, the relationship between increased SMBG and greater reductions in the A1C were mediated by greater weight loss.ConclusionsThe results of this study support the hypothesis that SMBG improves adherence to dietary recommendations. For patients who are taught to use diet as a weight loss tool, increased adherence to dietary recommendations is associated with increased weight loss and, subsequently, better glucose control. For patients with type 2 diabetes, SMBG may represent a valuable adjunctive intervention to existing behavioral programs.Cost-effective use of telemedicine and self-monitoring of blood glucose via Diabetes Tele Management System (DTMS) to achieve target glycosylated hemoglobin values without serious symptomatic hypoglycemia in 1,000 subjects with type 2 diabetes mellitus—a retrospective studyKesavadev J, Shankar A, Pillai PB, Krishnan G, Jothydev SJothydev's Diabetes and Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, IndiaDiabetes Technol Ther 2012; 14: 772–76ObjectiveThis study assessed the effectiveness, safety, and costs of the Diabetes Tele Management System (DTMS) in use at the Jothydev's Diabetes and Research Center (Kerala, India) for the care and follow-up of patients with type 2 diabetes (T2D) in South India.Research Design and MethodsThis retrospective cohort study relied on electronic health records from the Jothydev's Diabetes and Research Center. The patients included in the study had T2D and were 30–75 years old and eligible for a glycosylated hemoglobin (HbA1c) target <6.5%. They had enrolled in DTMS-based management and actively participated in various components of DTMS, such as regular reporting of self-monitoring of blood glucose (SMBG) values and dose adjustments via telemedicine. The HbA1c, lipid profile, and other parameters were measured at the first visit and on subsequent physical visits at months three and six and were used to estimate the incidence of hypoglycemia.ResultsWe analyzed records of 1,000 subjects with 6-month follow-up data (mean age, 53.2±9.8 years; 64% male). Patients had an average of 17±2 telemedicine follow-ups and reported 66,745 SMBG values over 6 months. The mean±SD HbA1c value was 8.5±1.4% at the initial visit and decreased to 6.3±0.6% at 6 months (P<0.0001). The rate of SMBG values <70 mg/dL was approximately 0.04/patient/month, with 84% of patients reporting no hypoglycemia. We calculated a recurring extra cost per patient for DTMS, not considering the cost of oral drugs and insulin to be U.S. $9.66/month.ConclusionsDTMS, comprising telemedicine follow-up and multidisciplinary care with SMBG-based monitoring, appears to be safe and cost-effective in the intensive treatment of patients with T2D who do not have serious co-morbidities. This system overcomes many of the limitations of traditional health care such as the need for frequent physical visits for drug dose adjustment, monitoring and modification of diet, and exercise advice.Telecare provides comparable efficacy to conventional self-monitored blood glucose in patients with type 2 diabetes titrating one injection of insulin glulisine—the ELEONOR studyDel Prato S1, Nicolucci A2, Lovagnini-Scher A3, Turco S4, Leotta S5, Vespasiani G6 on behalf of the ELEONOR Study Group1Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy; 2Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, Santa Maria Imbaro, Italy; 3San Gerardo Hospital Monza, Diabetes Center, Cusano Milanino, Italy; 4Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy; 5“Sandro Pertini” Hospital, Roma B, Italy; and 6Diabetology and Metabolic Disorders Center, Madonna del Soccorso Hospital, San Benedetto del Tronto, ItalyDiabetes Technol Ther 2012;14: 175–82BackgroundThis study compared the effectiveness of telecare and conventional self-monitored blood glucose (SMBG) programs for titrating the addition of a one-bolus injection of insulin glulisine in patients with type 2 diabetes uncontrolled on oral hypoglycemic agents for at least 3 months who were first titrated with basal insulin glargine.MethodsThis randomized, multicenter, parallel-group study included 241 patients who had a mean screening glycosylated hemoglobin [HbA(1c)] of 8.8% (73 mmol/mol). In the run-in phase, all antidiabetes medications except for metformin were discontinued. Metformin was then titrated up to 2 g/day (1 g twice daily) and continued at that dose until study completion. Following run-in, all patients received glargine for 8–16 weeks to achieve a target fasting plasma glucose (FPG) of 5.6 mmol/L using conventional SMBG. Patients who had FPG levels of 7 mmol/L or higher added a glulisine dose at the meal with the highest postprandial plasma glucose excursion, titrated to result in a 2-h postprandial plasma glucose level <7.8 mmol/L using telecare or SMBG for 24 weeks. Patients with FPG >7 mmol/L at week 16 were excluded from the study.ResultsFollowing glargine titration, 224 patients achieved FPG 7 mmol/L, and there was no significant difference between telecare and SBMG groups (mean±SD, 6.2±0.8 vs. 6.0±0.9 mmol/L, respectively). HbA(1c) levels were lower following titration and were similar for telecare and SMBG (7.9±0.9% vs. 7.8±0.9% [63 vs. 62 mmol/mol], respectively). The addition of glulisine led to a further reduction in HbA(1c), a decrease of 0.7% in both groups; 45.2% and 54.8% (P=0.14), respectively, of patients achieved HbA(1c) of 7.0% (53 mmol/mol). Weight change and hypoglycemia were similar between groups.ConclusionsWhen patients added one dose of glulisine at the meal with the highest postprandial plasma glucose excursion to titrated basal glargine, they achieved comparable improvements in glycemic control, as measured by HbA(1C), regardless of whether traditional or telecare monitoring of blood glucose was used.CommentsThese three studies highlight the need for better use of mobile technologies and telemedicine in improving health outcomes without additional financial burden. Frequent clinic visits are expensive, and in addition, due to the increasing prevalence of diabetes and lack of available endocrinologists/diabetologists and specialists, such modalities need to be properly reimbursed and encouraged.ACP Journal Club. Meta-analysis: self-monitoring in non-insulin-treated type 2 diabetes improved HbA1c by 0.25%Willett LRRobert Wood Johnson Medical School, New Brunswick, New JerseyAnn Intern Med. 2012 Jun; 156: JC6–12ObjectiveTo determine whether self-monitoring of blood glucose can improve glycemic control in patients with type 2 diabetes who do not use insulin.ScopeThis review included studies that compared self-monitoring of blood glucose (SMBG) with no SMBG in patients with non–insulin-treated type 2 diabetes. It included 80 patients with 6 months of follow-up. The primary outcome was HbA1c level; secondary outcomes were blood pressure and serum cholesterol level.Review MethodsThe search for randomized controlled trials (RCTs) was carried out on MEDLINE and EMBASE/Excerpta Medica (April 2009 to June 2010); the reference list of systematic reviews included studies from January 2000 to April 2009; reference lists of other reviews; conference proceedings; and a current controlled trials register. Individual patient data were obtained from the authors of selected studies. Six RCTs (n=2,552, mean age 60 years, 54% men) met the required inclusion criteria. Three of those RCTs described the randomization, and all had allocation concealment and blinded outcome assessors. Loss to follow-up ranged from 2% to 31% (mean 15%). The analysis was based on intention-to-treat.ResultsA meta-analysis of individual patient data indicated that SMBG led to a decrease in HbA1c levels at 3, 6, and 12 months compared with no self-monitoring. The mean pooled reduction in HbA1c was 9.6 mmol/mol (0.88%) in the intervention group and 7.5 mmol/mol (0.69%) in the usual care group. There was no significant difference in blood pressure or total cholesterol measurements between the groups. The results were similar across patients with different levels of HbA1c at baseline (P=0.3), including those with HbA1c >64 mmol/mol (>8%).ConclusionSelf-monitoring of blood glucose in patients with non–insulin-treated type 2 diabetes is associated with a reduction in HbA1c by 0.25% at 6 months compared with no self-monitoring.Self-monitoring of blood glucose in type 2 diabetes: cross-sectional analyses in 1993, 1999, and 2009Evans JM1, Mackison D1, Emslie-Smith A2, Lawton J31School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK; 2The Mill Practice, Dundee, University of Edinburgh, Edinburgh, UK; and 3Research Unit in Health, University of Edinburgh, Edinburgh, UKDiabet Med 2012;29: 792–5ObjectiveThis study assessed the number of test strips dispensed for self-monitoring of blood glucose (SMBG) to patients with type 2 diabetes in Tayside, Scotland, in 1993, 1999, and 2009.MethodsThe availability of a diabetes clinical information system in Tayside, Scotland, that was linked to electronic dispensed prescribing records made it possible to collate all dispensed prescribing records for three cross-sectional samples of patients with type 2 diabetes during three distinct year-long periods. The total patient sample was comprised of three groups: 1993 (n=5,728), 1999 (n=8,109), and January 2009 (n=16,450). The numbers of reagent strips dispensed during the relevant calendar year were calculated, and patients were stratified by treatment. We also explored the relationship between age, sex, material and social deprivation, and whether a patient received strips.ResultsThe proportions of people who received self-monitoring reagent strips increased from 15.5% in 1993 to 24.2% in 1999 to 29.8% in 2009; the numbers of strips dispensed also increased from year to year. While the proportion of diet-treated patients who received reagent strips remained low in 2009 (5.6%), the proportion of those treated with oral agents who received reagent strips tripled from 9.4% to 27.4% between 1993 and 2009. Over 90% of patients treated with insulin received reagent strips and, among non–insulin-treated patients, this was more common among women, younger people, and less deprived groups.ConclusionsThe numbers of reagent strips dispensed for SMBG has increased since 1993, and by 2009, almost all insulin-treated patients received strips. While few diet-treated patients received strips, their use appears to be more extensive among those treated with oral agents. Given that self-monitoring of blood glucose is no longer routinely recommended in non–insulin-treated patients, strategies to reduce unnecessary dispensing of reagent strips are needed.The role of self-monitoring of blood glucose in glucagon-like peptide-1-based treatment approaches: a European expert recommendationSchnell O1, Alawi H2, Battelino T3, Ceriello A4, Diem P5, Felton AM6, Grzeszczak W7, Harno K8, Kempler P9, Satman I10, Vergès B111Diabetes Research Grious, Helmholtz Center, Munich, Germany; 2Diabetes Centrum Saae, Saarlouis, Germany; 3University Children's Hospital, Ljubljana, Slovenia; 4Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigacion Biomédica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain; 5Bern University Hospital, Bern, Switzerland; 6Foundation of European Nurses in Diabetes, London, UK; 7Department of Internal Medicine and Diabetology, Faculty of Medicine, Zabrze, Poland; 8University of Eastern Finland, Kuopio, Finland; 9Semmelweis University, Budapest, Hungary; 10Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey; and 11Hopital due Bocage, Dijon, FranceJ Diabetes Sci Technol 2012;6: 665–73The role of glucagon-like peptide (GLP)-1 in the treatment of type 2 diabetes mellitus (T2DM) is increasing. Self-monitoring of blood glucose (SMBG) has been a component of numerous studies on GLP-1 analogs and dipeptidyl peptidase-4 inhibitors; however, the potential role of SMBG in GLP-1-based treatment approaches has not been clearly defined. The expert recommendation suggests the use of individualized SMBG strategies in GLP-1-based treatment approaches that incorporate simple and clinically applicable SMBG schemes. SMBG offers several potential benefits in GLP-1-based treatment approaches, including early assessment of treatment success or failure, timely modification of therapy, detection of hypoglycemic episodes, evaluation of glucose excursions, and support of diabetes management and diabetes education. The duration and frequency of SMBG should depend on the clinical setting and the degree of metabolic control. SMBG can play an important role in the optimization of diabetes management in T2DM patients treated with GLP-1-based approaches.Self-monitoring of blood glucose in patients with diabetes who do not use insulin—are guidelines evidence-based?Aakre KM1, Watine J2, Bunting PS3, Sandberg S1,4, Oosterhuis WP51Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway; 2Laboratoire de Biologie Polyvalente, Hôpital de la Chartreuse, Villefranche-de-Rouergue, France; 3Division of Biochemistry, The Ottawa Hospital, Ottawa, ON, Canada; 4The Norwegian Quality Improvement of Laboratory Services in Primary Care (NOKLUS), Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway; and 5Department of Clinical Chemistry, Atrium Medical Centre, Heerlen, The NetherlandsDiabet Med 2012 March. [Epub ahead of print]; DOI: 10.1111/j.1464-5491.2012.03659.x.ObjectiveThis study was intended to evaluate whether the clinical practice guidelines regarding self-monitoring of blood glucose (SMBG) in patients with diabetes who do not use insulin follow the principles of evidence-based medicine.MethodsA search of the literature from 1999 to 2011 led to the discovery of 18 clinical practice guidelines that were included in this study. Recommendations regarding SMBG were graded on a scale from one (strongly against self-monitoring) to four (strongly in favor of self-monitoring) and were compared with similarly graded conclusions of systematic reviews cited within the clinical practice guidelines. We also determined how certain characteristics of the clinical practice guidelines, such as funding sources and quality of references cited, could be related to the guideline recommendations.ResultsThis study included a total of 15 systematic reviews, 14 randomized controlled trials, 33 nonrandomized controlled trial papers, and 18 clinical practice guidelines or