Self-monitoring in diabetes mellitus

The role of glucose monitoring

Self-monitoring of blood glucose is considered an effective tool for the management of diabetes, especially for those who require insulin treatment.¹

Self-monitoring gives regular feedback for the patient; however, decisions on both the method and frequency of testing need to be made on an individual basis. Monitoring is only useful if it is used to inform decisions (eg, adjusting tablets or insulin dosage).

Diabetes empowerment improves diabetes self-care behaviours (including diet, physical activity, blood glucose monitoring and foot care).²

Studies have shown that when patients perform self-monitoring, support through appropriate educational initiatives is critical to ensure that patients understand the rationale for self-monitoring of blood glucose.³ See also the separate Diabetes Education and Self-management Programmes article.

Methods of monitoring glucose

Various methods of glucose monitoring are available, including HbA1c measurement, blood glucose monitoring and urine testing. NB: urine testing is not recommended but may be useful for some patients with diet- or tablet-controlled type 2 diabetes mellitus - for example, as a warning sign of high glucose levels when unwell.

Blood glucose monitoring⁴

Blood glucose monitoring using a meter gives a direct measure of the glucose concentration at the time of the test and can detect hypoglycaemia as well as hyperglycaemia.

Patients should be properly trained in the use of blood glucose monitoring systems and to take appropriate action on the results obtained. Inadequate understanding of the normal fluctuations in blood glucose can lead to confusion and inappropriate action.

Although glucose meters are not prescribable at NHS expense, manufacturers often provide them free to patients, on the basis of income made from the testing strips, which are prescribable at NHS expense and each type of testing strip is specific to each monitor.

Continuous glucose monitoring (CGM)

Subcutaneous CGM machines show real-time glucose on the monitor and have alarms to indicate hypoglycaemia and hyperglycaemia.⁵

Type 2 diabetes

National Institute for Health and Care Excellence (NICE) recommendations for patients with type 2 diabetes⁶

Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes unless:

• The person is on insulin; or

• There is evidence of hypoglycaemic episodes; or

• The person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery; or

• The person is pregnant or is planning to become pregnant.

Consider short-term self-monitoring of blood glucose levels in adults with type 2 diabetes (and review treatment as necessary):

• When starting treatment with oral or intravenous corticosteroids; or

• To confirm suspected hypoglycaemia.

If adults with type 2 diabetes are self-monitoring their blood glucose levels, carry out a structured assessment at least annually. The assessment should include:

• The person's self-monitoring skills.

• The quality and frequency of testing.

• Checking that the person knows how to interpret the blood glucose results and what action to take.

• The impact on the person's quality of life.

• The continued benefit to the person.

• The equipment used.

People with type 2 diabetes who are not using insulin

Although self-monitoring of blood glucose has been found to be effective for patients with type 1 diabetes and for patients with type 2 diabetes using insulin, evidence suggests that self-monitoring of blood glucose is of limited clinical effectiveness in improving glycaemic control in people with type 2 diabetes on oral agents or diet alone.⁷

A Cochrane review found that the overall effect of self-monitoring of blood glucose on glycaemic control in patients with type 2 diabetes who are not using insulin is small up to six months after initiation and subsides after 12 months.

There was no evidence that self-monitoring of blood glucose affected patient satisfaction, general well-being or general health-related quality of life.⁸