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AbstractSelf-monitoring of blood glucose (SMBG) is an important component of the management of type 1 and type 2 diabetes, enabling patients toimprove glycemic control. SMBG helps patients understand when hypoglycemia or hyperglycemia occurs in relation to medications, foodintake, health state, exercise or other activities, and facilitates patient education about diabetes and its management. However, effectiveutilization of SMBG requires that patients can correctly interpret their blood glucose results and take appropriate actions when needed. Inaddition, some blood glucose monitoring systems (BGMS) have limitations in terms of accuracy and ease of use. This article reviews the benefitsof SMBG and discusses factors affecting efficacy of SMBG. We describe several new features in OneTouch® BGMS (LifeScan Inc., Wayne, PA, US),designed to improve SMBG efficacy, and review pertinent data on accuracy, patient and healthcare provider satisfaction, and the impact of thesefeatures on patient decision-making and glycemic control.
KeywordsSelf-monitoring blood glucose, bloodglucose meter, blood glucose test strip DisclosureDisclosures: Laurence B Katz and Brian L Levy areemployees of LifeScan Inc. Mike Grady and StevenJ Setford are employees of LifeScan Scotland.Review Process: This supplement did not undergonethe journal’s standard peer review process, but wasreviewed by the Editorial Board for scientific accuracybefore publication.
AcknowledgementsAcknowledgements: Medical writing supportwas provided by Janet Manson at TouchMedical Media, funded by LifeScan Inc. Open AccessThis article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. ReceivedOctober 30, 2017 Published OnlineJanuary 22, 2018 CorrespondenceLaurence B Katz,965 Chesterbrook Boulevard, Wayne, PA19380, US. E: [email protected] SupportThe publication of this article wassupported by LifeScan Inc. The views and opinionsexpressed are those of the author and do notnecessarily reflect those of LifeScan Inc. Diabetes poses a huge health burden in the US. In the most recent national assessment for 2015, it is estimated that diabetes affects 9.4% of the US population, with costs of diagnosed diabetes reaching $245 billion annually.
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1 Additionally, it is estimated that 33.9% of US adults are prediabetic and 25.2% of those aged 65 years or older have a diagnoses of diabetes. 1 Diabetes is a complex disease requiring on-going medical care and patient self-management to prevent both acute complications and lower the risk of long-term health effects. 2 Although glycated hemoglobin (HbA1c) is considered the standard measure of long-term glycemic control in diabetes, it does not provide information regarding incidence of hypoglycemic events or glycemic variability. 3 Self-monitoring of blood glucose (SMBG) by patients is an integral part of intensive glycemic treatment, widely believed to improve the control of blood glucose (BG) levels and health outcomes. 4Benefits of self-monitoring of blood glucoseSMBG is an important component of disease management in both type 1 diabetes (T1D) and type 2 diabetes (T2D), allowing patients to evaluate their individual response to therapy and assess whether they are achieving glycemic targets. 5,6 Furthermore, SMBG helps patients with diabetes in many ways including: immediately confirming hypoglycemia or hyperglycemia; detecting BG levels that are “out-of-range” so therapeutic adjustments can be made to meet long-term glycemic targets; facilitating patient education as to glycemic responses to medications, food, health state, exercise, or other activities; giving patients more responsibility in the self-management of their disease; and it can help to motivate healthier behaviors in patients.
7While SMBG is crucial to the self-management of insulin-treated diabetes, the benefit of SMBG has not been demonstrated consistently in non-insulin treated T2D. 8-12 However, variations in study population, design, and type of SMBG intervention may contribute to the lack of consistent findings. The most recent meta-analysis on SMBG, encompassing 15 randomized clinical trials, and a total of 3,383 patients, concluded that SMBG improved HbA1c levels, both short-term (≤6-month follow-up) and long-term (≥12-month follow-up), in patients with T2D who were not using insulin. 13Factors effecting efficacy in self-monitoring of blood glucoseStudies on the efficacy of SMBG often fail to consider how real-world conditions can affect the performance of monitoring equipment, and that patients vary in their ability to interpret and take action on test results. Inaccurate blood glucose monitoring systems (BGMS) can also lead to adverse health effects, and there is a growing need for post-market surveillance to ensure that these systems routinely meet their labeled accuracy performance in real-world settings.
14 Additionally, the benefits of SMBG can be negated by poor patient education on how to interpret the numbers displayed, coupled with a lack of understanding about appropriate interventions following out-of-range BG readings.Accuracy standardsIn 2013, revisions were made to the 2003 International Organization for Standardization (ISO) ISO BGMS accuracy standards (ISO) to address the need for more stringent accuracy requirements. 15 The requirement states that 95% of BG readings fall within 15 mg/dl (for BG. CDC, 2017 National Diabetes Statistics Report 2017. Available at: www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf (accessed June 25, 2017). American Diabetes Association.