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30-07-2018 | Blood glucose monitoring | Article

Real-world use of self-monitoring of blood glucose in people with type 2 diabetes: an urgent need for improvement

Journal: Acta Diabetologica

Authors: Maria Chiara Rossi, Giuseppe Lucisano, Antonio Ceriello, Chiara Mazzucchelli, Nicoletta Musacchio, Alessandro Ozzello, Antonio Nicolucci, Paolo Di Bartolo, the AMD Annals-SMBG Study Group

Publisher: Springer Milan



To assess use of self-monitoring of blood glucose (SMBG) in type 2 diabetes (T2DM) in the context of a continuous quality improvement initiative (AMD Annals).


14 quality-of-care indicators were developed, including frequency of SMBG, fasting blood glucose (FBG), and post-prandial glucose (PPG) levels, and hypoglycemia and hyperglycemia episodes. Clinical data and SMBG values downloaded from any glucose meter were obtained from electronic medical records. The most frequently used glucose-lowering treatment regimens were identified and the indicators were assessed separately by regimen.


Overall, 21 Italian centers and 13,331 patients (accounting for 35,657 HbA1c tests and 8.44 million SMBG values collected during 2014 and 2015) were included in the analysis; 11 therapeutic regimens were selected. Patients in regimens not including insulin performed 15–23 measurements per patient-month, those treated with basal insulin 32.1 tests/patient-month, and those treated with basal and short-acting insulin 53–58 tests/patient-month. In all treatment regimens, PPG measurements represented a minority of all tests; pre-breakfast measurements accounted for about 50% of all FBG values. Mean FBG levels exceeded 130 mg/dl in 49.3–88.3% of the cases in the different treatment regimens, while PPG levels were over 140 mg/dl in 46.7–81.0%. From 5.7 to 32.7%, patients in the different regimens had at least one episode of hypoglycemia (< 70 mg/dl), while from 3.7 to 47.7% had at least one episode of hyperglycemia (> 300 mg/dl).


SMBG is underutilized in patients with T2DM treated or not with insulin. In all treatment groups, PPG is seldom investigated. Poor metabolic control and rates of hyper- and hypoglycemia deserve consideration in all treatment groups.
Inzucchi SE, Bergenstal RM, Buse JB et al (2012) Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 35:136413–136479 (Erratum in: Diabetes Care 2013;36:490) CrossRef
Ceriello A, Gallo M, Armentano V et al (2012) Personalizing treatment in type 2 diabetes: a self-monitoring of blood glucose inclusive innovative approach. Diabetes Technol Ther 14:373–378CrossRefPubMed
Ceriello A, Genovese S, Bosi E (2016) The evolving frontier of diabetes therapy: the renaissance of glycemology. Diabetes Res Clin Pract 118:168–171CrossRefPubMed
Ceriello A, Gallo M, Candido R et al (2014) Personalized therapy algorithms for type 2 diabetes: a phenotype-based approach. Pharmgenomics Pers Med 7:129–136PubMedPubMedCentral
American Diabetes Association (2017) Standards of medical care in diabetes—2017. Diabetes Care 40:S1–S138 (last accessed November 9, 2017) CrossRef
International Diabetes Federation (2012) Clinical guidelines task force. Global guideline for type 2 diabetes. https://​www.​idf.​org/​e-library/​guidelines.​html. Accessed 9 Nov 2017
AMD-SID (2016) Standard italiani per la cura del diabete mellito 2016. http://​www.​standarditaliani​.​it. Accessed 9 Nov 2017 (Italian)
Malanda UL, Welschen LM, Riphagen II, Dekker JM, Nijpels G, Bot SD (2012) Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev 1:CD005060PubMed
Parkin CG, Buskirk A, Hinnen DA, Axel-Schweitzer M (2012) Results that matter: structured vs. unstructured self-monitoring of blood glucose in type 2 diabetes. Diabetes Res Clin Pract 97:6–15CrossRefPubMed
International Diabetes Federation Clinical Guidelines Taskforce and International SMBG Working Group (2009) Global guideline on self-monitoring of blood glucose in noninsulin treated type 2 diabetes. https://​www.​idf.​org/​e-library/​guidelines/​85-self-monitoring-of-blood-glucose-in-non-insulin-treated-type-2-diabetes.​html. Accessed 9 Nov 2017
Schnell O, Alawi H, Battelino T, Ceriello A (2009) Consensus statement on self-monitoring of blood glucose in diabetes: a European perspective. Diabetes Metab Heart 18:285–289
Franciosi M, Pellegrini F, De Berardis G et al (2001) The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies. Diabetes Care 24:1870–1877CrossRefPubMed
Klonoff DC, Blonde L, Cembrowski G et al (2011) Consensus report: the current role of self-monitoring of blood glucose in non-insulin-treated type 2 diabetes. J Diabetes Sci Technol 5:1529–1548CrossRefPubMedPubMedCentral
Rossi MC1, Candido R, Ceriello A et al (2015) Trends over 8 years in quality of diabetes care: results of the AMD Annals continuous quality improvement initiative. Acta Diabetol 52:557–571CrossRefPubMed
Schnell O, Alawi H, Battelino T et al (2011) Addressing schemes of self-monitoring of blood glucose in type 2 diabetes: a European perspective and expert recommendation. Diabetes Technol Ther 13:959–965CrossRefPubMed
Allemann S, Houriet C, Diem P, Stettler C (2009) Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis. Curr Med Res Opin 25:2903–2913CrossRefPubMed
Peel E, Parry O, Douglas M, Lawton J (2004) Blood glucose selfmonitoring in non-insulin-treated type 2 diabetes: a qualitative study of patients’ perspectives. Br J Gen Pract 54:183–188PubMedPubMedCentral
Cox DJ, Gonder-Frederick L, Ritterband L, Clarke W, Kovatchev BP (2007) Prediction of severe hypoglycemia. Diabetes Care 30:1370–1373CrossRefPubMed
Tavares R, Duclos M, Brabant MJ et al (2016) Differences in self-monitored, blood glucose test strip utilization by therapy for type 2 diabetes mellitus. Acta Diabetol 53:483–492CrossRefPubMedPubMedCentral
Farmer A, Balman E, Gadsby R et al (2008) Frequency of self-monitoring of blood glucose in patients with type 2 diabetes: association with hypoglycaemic events. Curr Med Res Opin 24:3097–3104CrossRefPubMed
Lecomte P, Romon I, Fosse S, Simon D, Fagot-Campagna A (2008) Self-monitoring of blood glucose in people with type 1 and type 2 diabetes living in France: the Entred study 2001. Diabetes Metab 34:219–226CrossRefPubMed
Metcalfe S, Moodie P, Norris H, Rasiah D (2014) Self-monitoring blood glucose test strip use with diabetes medicines in people with types 1 and 2 diabetes in New Zealand. N Z Med J 127:48–62PubMed

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