Self - monitoring in diabetes

Summary points about self-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 of blood glucose might be most appropriate for patients with type I or type II diabetes who use insulin and adjust their dose as a result of blood glucose testing, and for all diabetics when they have intercurrent illness
• the ideal frequency of self-monitoring in type II diabetes is not known
• there is no evidence that blood testing is more effective than urine testing at improving blood glucose control in people with type II diabetes

Continuous Glucose Monitoring (CGM) (2)

Subcutaneous CGM machines show real-time glucose on the monitor and have alarms to indicate hypoglycaemia and hyperglycaemia. Use of CGM is now recommended at diabetes onset and anytime thereafter for children, adolescents, and adults with diabetes who are on insulin therapy, on noninsulin therapies that can cause hypoglycemia, and on any diabetes treatment where CGM helps in management.

CGM provides continuous, real-time glucose data with trend information (rate and direction of change) rather than single-point measurements; reduces the need for frequent fingerstick testing; enables detection of nocturnal and asymptomatic hypoglycaemia, and has demonstrated improvements in glycaemic control across diabetes types.

Note: NICE recommendations for patients with type 2 diabetes are: (3)

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.

Reference:

1. Russell-Minda E, Jutai J, Speechley M, et al; Health technologies for monitoring and managing diabetes: a systematic review. J Diabetes Sci Technol. 2009 Nov 1;3(6):1460-71.
2. American Diabetes Association Professional Practice Committee for Diabetes. 7. Diabetes Technology: Standards of Care in Diabetes-2026. Diabetes Care. 2026 Jan 01;49(Supplement_1):S150-S165.
3. Type 2 diabetes in adults: management; NICE Guidance (December 2015 - last updated June 2022)