Self-monitoring as an important tool in preventing diabetes complications - Evidence from the real world

Smokovski, Ivica (2019) Self-monitoring as an important tool in preventing diabetes complications - Evidence from the real world. In: IDF Congress 2019.

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Despite the increasing use of Continuous Glucose Monitoring (CGM), Self-Monitoring of Blood Glucose (SMBG), although in use for almost four decades, remains the cornerstone of home and hospital glucose monitoring for majority of diabetes patients worldwide.
As demonstrated in large clinical trials that included SMBG as part of multifactorial intervention, glycemic control in diabetes remains essential to prevent microvascular complications and reduce long-term risk of macrovascular disease.
For patients on insulin treatment, frequent SMBG is key for achieving recommended glycemic targets, and prevention of hypoglycemia and hyperglycemia.
Increased daily frequency of SMBG in type 1 diabetes patients was significantly associated with lower HbA1c, and fewer acute complications
Randomized controlled and observational trials in non-insulin treated type 2 diabetes patients about the use of SMBG for improvement of glycaemic control and/or reduction of hypoglycemic risk, provided mixed results.
SMBG remains essential tool of proactive diabetes care approach in these patients, as it provides immediate feedback on glycaemic control, rather than waiting months for the next HbA1c.
SMBG is necessary for education of non-insulin treated type 2 diabetes patients, and should be individualized in terms of frequency, timing and communication with healthcare providers, as part of structured diabetes management.
Recent randomized controlled trial on the use of structured SMBG in non-insulin treated type 2 diabetes patients provided mean reduction in HbA1c of 0.9%.
HbA1c is recognized as key surrogate marker for development of long-term diabetes complications; however, its numerous limitations (lack of information on acute complications of hypo- and hyperglycemia, and glucose variability; confounded by conditions such as anemia, hemoglobinopathies, iron deficiency, and pregnancy), resulted in a need for novel metrics of glucose control (glucometrics), such as Mean Glucose; Time in Range (TIR); Time Above Range (TAR); Time Below Range (TBR); Glucose Management Indicator (GMI); Glycemic Variability (GV); Ambulatory Glucose Profile (AGP).
Although primarily developed for CGM, glucometrics could also be applied for use with SMBG (Mean and Median Glucose; Standard Deviation; % Coefficient of Variation; Interquartile Range, Minimum, Maximum; Glucose Profile by Time of Day and by Date; Percentage of Time in Range, Above Range, Below Range; integration with insulin dose, medication, meal, exercise).
Analysis of 7-point SMBG data from the Diabetes Control and Complications Trial (DCCT) demonstrated correlations of TIR with diabetes complications.
Accuracy is crucial for reliable use of SMBG in real world, and two most used standards for accuracy of blood glucose monitors are those of International Organization for Standardization (ISO 15197:2013) and FDA.
Healthcare providers need to be familiar with measures of accuracy, such as, bias; precision; arithmetic and absolute deviation; Absolute Relative Difference (ARD) – Mean ARD (MARD) and Median ARD (MedARD); Rectangle Target Plot.
Although healthcare providers and patients assume that regulatory approved blood glucose monitors are accurate, recent analysis found that only 6 of top 18 glucose meters met the accuracy standard.
Some of factors known to affect SMBG accuracy include higher and lower oxygen tension conditions, temperature, interfering substances, manufacturing defects, test strip lot-to-lot variation, alternate site testing, skin contaminants.
Considerable increase in the number of free test strips for type 1 and insulin-treated type 2 diabetes patients was identified as a single most important event resulting in 10% reduction in cases of diabetic ketoacidosis after 2 years.
Recent real-world studies reported that SMBG is underutilized in patients with type 2 diabetes treated or not with insulin; that postprandial glycaemia is seldom investigated; and poor metabolic control with unsatisfactory rates of hyper- and hypoglycemia was observed.
Unfortunately, there are still countries where SMBG is not available, or is available for minority of patients who mostly perform it once a month, or at no regular interval.
In conclusion, SMBG is not a stand-alone activity; rather a part of a multi-component diabetes care program; and, despite emerging technologies, it is here to stay, as no diabetes management is possible without measurement of glycaemia.

Item Type: Conference or Workshop Item (Lecture)
Subjects: Medical and Health Sciences > Clinical medicine
Divisions: Faculty of Medical Science
Depositing User: Ivica Smokovski
Date Deposited: 16 Sep 2020 07:24
Last Modified: 16 Sep 2020 07:24

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