RSSDI consensus on self-monitoring of blood glucose in types 1 and 2 diabetes mellitus in India

Abstract

Maintaining a good glycemic control is crucial in the management of diabetes mellitus (DM) as it is associated with the reduction in both macro and microvascular complications of the disease. Self-monitoring of blood glucose (SMBG), which provides the day-today blood glucose levels, is a simple and practical tool for maintaining a good glycemic control. Although SMBG is widely practiced in other countries, its use in India is very limited. Even when used, it is not carried out is a structured manner. There seems to be a lack of education about the purpose of SMBG and the correct process and schedule to be followed. This highlights the unmet need for country-specific SMBG recommendations. In order to fulfil this need, a panel of expert endocrinologists/ diabetologists came together under the aegis of Research Society for the Study of Diabetes in India (RSSDI). They reviewed the current literature, combined the evidences with their clinical knowledge and expertise, and developed consensus recommendations for SMBG practice in India. This document provides a comprehensive review of the current literature on SMBG and presents the recommendations made by the expert panel.

RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020

“…[ 683 ] Glycated haemoglobin (HbA1c), which assesses the average level of blood glucose over 3 months, and self-monitoring of blood glucose (SMBG), which records the day-to-day blood glucose levels, are the two important tools for monitoring of glycaemic control. [ 684 ] Measurement of HbA1c is known as a gold standard approach for monitoring diabetes in both research and in clinical settings[ 685 686 687 ] Most guidelines recommend clinicians must perform HbA1c measurements routinely in all patients with T2DM as a part of continuing care. [ 688 689 ] Long-term hyperglycaemia as measured by HbA1C is associated with secondary macro-and micro-vascular complications due to diabetes.…”

“…SMBG is an essential component of the modern diabetes treatment, it is the simplest and possibly most practical tool to assess efficacy and safety of glycaemic control. [ 697 698 ] SMBG facilitates patients and healthcare providersto adjust their therapeutic regimen in response to blood glucose values and regulate the dietary intake, physical activity, and insulin doses to improve glycaemic control on a regular basis. [ 692 699 ] Established advantages with SMBG include, achieving target HbA1c, reducing glucose variability and prediction of severe hypoglycaemia.…”

“…Selecting a structured, flexible SMBG pattern that can be tailored to the clinical, educational, behavioural, and financial requirements of individuals with diabetes is recommended. [ 698 ] As it is important to determine the frequency and intensity of SMBG needed to support the chosen treatment regimen, one should also consider practical obstacles to monitoring, such as affordability or access and individualize glycaemic target and modify monitoring patterns accordingly. [ 704 705 ]…”

“…Ideal SMBG: seven tests/day i. e. three before and three after each meal and one test at 3 am. [ 684 ] Pregnant women on lifestyle modifications should have a day profile once a week. This should include one fasting and three post-prandial values at least once a week or staggered over a week.…”

“…This should include one fasting and three post-prandial values at least once a week or staggered over a week. [ 684 ] In elderly patients, the frequency of SMBG should be once daily (different time each day) in the initiation phase and later it should be reduced further to two to three times per week. …”