Self Monitoring Of Blood Glucose
Self monitoring of blood glucose or SMBG refers to home blood glucose testing for people with diabetes.
Self monitoring is the use of regular blood testing to understand ones diabetes control and inform changes to improve ones control or wider regime.
Self monitoring of blood glucose levels has been a hotly disputed issue for a number of years, particularly with regards to people with type 2 diabetes who are not on insulin.
For information and advice on what to do if your access to testing supplies is restricted, see our availability of test strips page.
What Is The Evidence Of Effectiveness Of Smbg
SMBG is commonly used in developed nations as an integral part of diabetes management . In a survey conducted in Canada in 2011, almost 90% of the patients with type 2 DM reported using SMBG. Further, there was no significant difference between patients using insulin only and those taking insulin plus oral medication or an oral medication only although frequency of SMBG was lower in these patients . In another survey conducted in the UK, 80% of the 554 respondents reported high satisfaction with SMBG. They also reported that SMBG helped them feel more âin controlâ of their diabetes management .
Reducing Pain When Testing
A common complaint about glucose self-monitoring is that it hurts. Below are some tips for reducing pain when testing:
Use a new lancet for each blood glucose check.
Choose a lancet device with a depth gauge and select the lowest setting that allows for a sufficient sample size.
Lancets come in a variety of sizes, typically from 28 gauge to 33 gauge, so choose a lancet with a smaller gauge .
Poke the side of the fingertip instead of the end or the middle.
Alternate the fingers instead of repeatedly using the same finger.
To minimize pain from forceful squeezing of the fingertip to get a sufficient blood sample, start squeezing the palm and push the blood progressively into the fingertip.
Consider alternate-site testing, especially if you have painful upper-extremity neuropathy.
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Reducing Hemoglobin A1c Levels Minimizing Glucose Variability And Detecting Severe Hypoglycemia In The Outcome Reduction With An Initial Glargine Intervention Trial
In the recently completed Outcome Reduction with an Initial Glargine INtervention trial conducted in dysglycemic patients with cardiovascular risk factors, all eligible participants were taught to measure their own blood glucose levels at trial onset prior to randomization. SMBG served as a key pillar of diabetes management for patients receiving insulin glargine. Participants in this treatment arm were instructed to take daily fasting plasma glucose readings until they reached self-measured FPG levels between 72 mg/dl and 95 mg/dl, and then at least twice per week. Insulin glargine was uptitrated weekly as necessary through the use of an algorithm. Patients with T2D, present at baseline or developed during the trial, receiving standard care were provided with self-glucose monitoring equipment and support.12
Insulin glargine had a neutral effect on CV outcomes, with incidence rates of 2.94 and 2.85 per 100 person-years observed in the insulin glargine and standard care groups, respectively. There was no significant increase in the risk of death from CV causes, nonfatal myocardial infarction or nonfatal stroke in patients with preexisting CV disease versus those with no CV history.13 Individuals using SMBG to adjust their daily dose of basal insulin were reported to be approximately 3-fold more likely to achieve and maintain near-normal glycemic levels, defined as HbA1c < 6.5%, compared with individuals receiving standard care .2
How To I Make Sure The Results Are Accurate
You can verify that your glucose reader and test strips are working together properly using the control solution that usually comes with the meter. If not, you can buy the control solution at most drugstores, or directly from the manufacturer. We recommend that you check the accuracy of your meters readings at least once a year by comparing a fasting reading with a reading done at the same time in a laboratory. Consult a health professional about the acceptable variance between the two readings. Also, always follow your meters user instructions.
- To avoid false readings, your test strips and glucose meter must be in good condition. Make sure that:
- The expiry date printed on the test-strip container has not been reached or exceeded
- The test-strip container was not left open after you took out a test strip
- The test strips are in their original container
- The test strips have been kept away from moisture, and stored at a temperature between 4 and 30 degrees Celsius
- The test strips have not been contaminated by dust or other substances
- There is no dust or dried blood on the opening of the test strip
- The glucose meter has not been left in direct sunlight
- The glucose meter has not been exposed to moisture, or to temperatures below 5 degrees Celsius or higher than 30 degrees Celsius
- The glucose meter has not been dropped, or been in contact with a liquid
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Supporting Patient Empowerment Through Disease Self
The use of SMBG in clinical trials allows patients to become more involved in their own treatment and this sense of empowerment has been found to be essential to motivating patients to achieve treatment targets.23
Another trial where patients played an important role in directing their treatment by SMBG was the Treat to Target with Once-Daily Insulin Therapy: Reduce A1C by Titrating Effectively study. TITRATE was the first prospective randomized study to examine the effect of different FPG targets on glycemic control using patient-directed titration of once-daily insulin detemir. The aim of the study was to compare the efficacy and safety of 2 FPG titration targets in insulin-naïve subjects with T2D insufficiently controlled on oral antidiabetics. A patient-directed, treat-to-target algorithm was used based on which subjects self-titrated their insulin detemir dose every 3 days according to the mean FPG level of daily readings taken in the previous 3 days. Patients received further support in the form of a patient card , a patient training booklet, education and counseling sessions, office visits, and frequent phone contact.23
Smbg Practice In India And Unmet Need For Country
Burden of DM in India is very high and it is projected to get worse in the coming years. SMBG, with its potential to help in achieving good glycemic control and reducing the risk of both short-and long-term complications, can serve as an apt measure to deal with DM. While SMBG is widely used in other parts of the world, it is less commonly practiced in India. The SMBG International Working Group, in 2008, conducted a survey to study the use of SMBG in 13 countries including India. The lowest use of SMBG was found in India . A study conducted in Delhi to evaluate the quality of care in patients from the middle- and high-income group found that 28.4% of the patients had a home blood glucose monitoring device, and 77.4% of the patients were following the advice on SMBG . Table 4 shows the estimated SMBG use in different countries.
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Ready To Have Freedom At Your Fingertip
POGO Automatic is the only FDA-cleared blood glucose monitor that lances and collects blood automatically, in one simple step, with its 10-test cartridge technology, eliminating the need to carry separate lancets and test strips. Reach out today to learn more about how you can test your blood without interrupting your day.
Choosing A Blood Glucose Meter
Barring any special needs of the patient, meters are often selected on the basis of the patients insurance coverage for self-monitoring supplies , because of the high cost of test strips when purchased out-of-pocket. Meters themselves are usually relatively inexpensive, since the manufacturers commonly give them away as free samples to providers, who pass them along to patients. They also can often be purchased using coupons at a significant discount.
Without insurance coverage, test strips can cost $0.83 to $1.76 per strip for the most popular brands of meters. For patients without insurance coverage for supplies, the lowest-cost test strips currently available are for the ReliOn Prime Blood Glucose Monitoring System sold at Walmart. Although ReliOn meters are not given out as samples in providers offices, the manufacturers suggested retail price is $16.24. More importantly, the suggested retail price for ReliOn Prime test strips is $9.00 for a bottle of 50 strips, or $0.18 per strip.
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Diabetes Control And Complications Trial And The Epidemiology Of Diabetes Interventions And Complicationsestablishing The Standard Of Care For Patients With T1d
Although the results from the Diabetes Control and Complications Trial were published in 1993, this landmark trial broadened our knowledge and helped establish SMBG as the standard of care for patients with T1D.25,26 It demonstrated the impact of near-normal glycemic control on reducing the development and progression of microvascular and neurological complications in patients with T1D. Participants receiving intensive therapy used SMBG, and additional factors such as dietary intake and expected exercise, to adjust their insulin dosage. Readings were taken 4 times daily to meet target preprandial glucose levels of 70-120 mg/dl, PPG levels of < 180 mg/dl, weekly 3 a.m. measurements of > 65 mg/dl and monthly HbA1c measurements of < 6.05%. Those in the conventional group took daily SMBG readings, but did not use these for self-titration.25
SMBG was 1 of the key technologies that made the facilitation of DCCT possible, allowing participants to be followed for a mean of 6.5 years.25 Results from the trial provided evidence that intensive insulin therapy effectively delays the onset and progression of nephropathy, neuropathy, and retinopathy by 35-90% compared to conventional insulin therapy. The authors concluded that intensive intervention was most effective when begun early, before complications were detectable.25,27
Traditional Blood Glucose Meters
Traditional blood glucose meters are used with accompanying lancets and test strips. To use a traditional BGM, you typically insert the strip into the meter, prick your finger with a lancet, and place a drop of blood on the test strip. If your meter has Bluetooth connectivity, it can upload your result to the meters accompanying mobile app.
While traditional BGMs are the most common method of self-monitoring blood glucose, they can present several challenges. For one, they require you to use separate test strips and lancets, which makes checking your blood sugar more tedious since you have to keep track of multiple testing components. With a busy lifestyle and a lively household, it can be difficult to test with traditional BGMs.
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Meters With Advanced Functions
For patients who want or need more advanced options, meters are now offering more feedback.
The OneTouch Verio family of meters helps patients spot patterns in their blood glucose levels. In addition, the Verio Flex and Verio Sync meters can sync with the OneTouch Reveal mobile app, which provides reports for the patient to view and send to the healthcare provider.
The Accu-Chek Aviva Expert has a bolus calculation function. Settings such as carbohydrate ratios, insulin sensitivity, targets, and active insulin can be programmed into the meter, which uses this information to give the patient dosing suggestions for rapid-acting insulin when carbohydrate intake is entered or blood glucose levels are checked. Another Accu-Chek meter, the Aviva Connect, can wirelessly transmit blood glucose results to the Accu-Chek Connect mobile app.
For a complete and regularly updated list of meters and their features, we encourage patients and healthcare providers to refer to the ADAs Diabetes Forecast magazine. The magazine publishes a consumer guide every January that includes a comprehensive list of blood glucose meters. Past issues of the guide are available at www.diabetesforecast.org/past-issues-archive.html.
Whether And How Often To Monitor
In clinical practice, advice about whether patients should monitor their blood glucose levels and how often to do it depends on the type of diabetes therapy, the need to titrate the dose or change the regimen, and the patients preferences, dexterity, and visual acuity. The frequency of testing also often depends on financial considerations and insurance coverage.
In patients with type 1 diabetes and insulin-treated type 2 diabetes, the role of glucose self-monitoring is clear. The American Diabetes Association recommends that patients receiving multiple insulin injections daily or on an insulin pump measure their blood glucose at least before meals and snacks, occasionally after meals, at bedtime, before exercise, when they suspect their blood glucose level is low, after treating low blood glucose until they are normoglycemic, and before critical tasks such as driving.
The Diabetes Control and Complications Trial and the DCCT/Epidemiology of Diabetes Interventions and Complications study showed that intensive insulin therapy effectively delays the onset and slows the progression of microvascular and macrovacscular disease. Self-monitoring of blood glucose is an integral part of intensive insulin therapy, allowing for dose adjustments based on immediate blood glucose readings, thereby reducing the risks of hyperglycemia and hypoglycemia.
For patients taking a single daily dose of basal insulin, fasting blood glucose values are often used to titrate the basal insulin dose.
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Major Exposure Variable: Self
Frequency of performing SMBG was determined by checking the glucometers recordings and/or the patients diaries at baseline and at 12 months thereafter . SMBG was defined as self-assessment of blood glucose levels using a glucometer more than once per week. Participants were then categorized into early SMBG users and non-users groups based on availability of SMBG data at baseline. Considering that availability of baseline SMBG data does not represent continuation of SMBG throughout the entire year, data collected at the end-point was incorporated into analysis, after which participants were divided into four groups: SMBG group , SMBG group , SMBG group and SMBG group .
Lancets Lancing Devices And Techniques
Along with a variety of meters, patients also have an array of lancets and lancing devices from which to choose. Many patients use the brand of lancet device and lancets that come in their meter starter kit, but they can use other brands if desired. For cost-conscious patients, lancets are significantly more affordable than test strips, even for those without insurance coverage. Prices can be as low as $0.03 per lancet for some store-brand 33-gauge lancets. Name-brand lancets are more expensive than store-brand, but at $0.06 to $0.16 per lancet, many patients will even find these to be affordable if they must pay out of pocket.
Special needs may also prompt patients to choose a different lancet device than the one that came with their meter. For patients who have poor dexterity or are afraid to look at needles, the Accu-Chek FastClix lancing device uses drums with six preloaded lancets, eliminating the need to see and handle individual lancets. The FastClix device is included in the starter kits for the Accu-Chek Nano and Accu-Chek Connect meters and can also be ordered separately at pharmacies.
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Key Questions Answered By The Report
- What is the growth prospect of the Self-Monitoring Blood Glucose Strips market? What are key factors, such as drivers, opportunities, and trends, that govern the market?
- What are the key sustainability strategies adopted by leading players operating in the Self-Monitoring Blood Glucose Strips market?
- What are the new emerging technologies and use cases disrupting the Self-Monitoring Blood Glucose Strips market?
- What are the key trends and opportunities in the Self-Monitoring Blood Glucose Strips market across different regions and their respective countries?
- Who are the key players and innovators in the ecosystem of the Self-Monitoring Blood Glucose Strips market?
Automatic Blood Glucose Monitors
All-in-one, automatic blood glucose monitors make self-monitoring blood glucose at home or on the go fast, accurate, and discreet. The POGO Automatic® Monitor is the first FDA-cleared automatic monitoring system with 10-test cartridge technology that eliminates the need for separate test strips and lancets. With POGO Automatic, you simply press a button, and lancing and blood collection are done for you. Your results are displayed within seconds, and they sync with the free Patterns® for POGO Automatic app via Bluetooth. The Patterns app helps with paired testing because it allows you to track and manage specific trends, whether youre pairing to meals, exercise, or other significant factors. POGO Automatic also offers an easy way to share your results with your healthcare provider.
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Significance Of This Study
What is already known about this subject?
Frequency of self-monitoring of blood glucose correlates with hemoglobin A1c and is considered an important factor for obtaining good glycemic control.
Earlier studies on patients with diabetes type 1 have shown varying compliance to previous and current American Diabetes Association guidelines, from two thirds of patients not performing daily SMBG, to 85% of patients measuring three times per day or more.
What are the new findings?
Less than 50% of persons with type 1 diabetes in Sweden perform SMBG4 per day according to current ADA guidelines.
30% of patients are unaware of guidelines.
The top two most reported reasons for not performing more frequent SMBG were not remembering and lack of time.
How might these results change the focus of research or clinical practice?
Our results indicate a need for further supporting SMBG with repeated and focused information on current guidelines as well as continued development of user-friendly glucose-monitoring devices.
Are There Problems With Self
A person with diabetes may find self-monitoring problematic for several reasons: the need to carry materials and prick themselves several times per day, frustration with unexpected results. Nevertheless, when a person self-monitors according to the recommendations, and understands the benefits of this approach, self-monitoring becomes an important resource.
Self-monitoring lets you:
- Check the impact of different treatment elements on your blood glucose and make adjustments, if necessary.
- Complete the information provided by glycated hemoglobin .
- Identify, quickly treat and prevent hypoglycemia or hyperglycemia.
- Develop confidence, autonomy and feel safe.
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