Self-Monitoring of Blood Glucose in Diabetes: From Evidence to Clinical Reality in Central and Eastern Europe—Recommendations from the International Central-Eastern European Expert Group

Abstract

Self-monitoring of blood glucose (SMBG) is universally considered to be an integral part of type 1 diabetes management and crucial for optimizing the safety and efficacy of complex insulin regimens. This extends to type 2 diabetes patients on intensive insulin therapy, and there is also a growing body of evidence suggesting that structured SMBG is beneficial for all type 2 diabetes patients, regardless of therapy. However, access to SMBG can be limited in many countries in Central and Eastern Europe. A consensus group of diabetes experts from 10 countries in this region (with overlapping historical, political, and social environments)-Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, Slovenia, and Ukraine-was formed to discuss the role of SMBG across the spectrum of patients with diabetes. The group considered SMBG to be an essential tool that should be accessible to all patients with diabetes, including those with non-insulin-treated type 2 diabetes. The current article summarizes the evidence put forward by the consensus group and provides their recommendations for the appropriate use of SMBG as part of individualized patient management. The ultimate goal of these evidence-based recommendations is to help patients and providers in Central and Eastern Europe to make optimal use of SMBG in order to maximize the efficacy and safety of glucose-lowering therapies, to prevent complications, and to empower the patient to play a more active role in the management of their diabetes.

American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

“…Methods for communication of glucose data are shown in Table 3. Two of the goals for any BGM strategy are to empower patients to play a more active role in their diabetes management and to maximize the efficacy and safety of glucose-lowering therapies, including lifestyle management (94). GM results are also a vital component of the data that should be presented to the diabetes care clinician at each medical appointment, and potentially between visits, to assist in therapy titration.…”

“…Daily BGM has not been shown to be effective in patients on diet/lifestyle therapy who are at low risk for hypoglycemia (28,33,35,94). However, structured testing may help patients improve their understanding of the effectiveness of medical nutrition therapy (MNT) and lifestyle management.…”

Is it beneficial to the state to provide insulin-treated diabetic patients with public funds for self-monitoring blood glucose?

“…Снижение на 1% уровня гликированного гемогло-бина (HbA 1c ) способно: -среди больных СД2 снизить все осложне-ния на 21%, смертность, обусловленную СД, на 21% [12]. Также делалось предположение, что другие рассматриваемые показатели клинических исходов (развитие осложнений, инвалидность и средняя продолжительность больничного листа) также сокращаются на 21%; -среди больных СД1 снизить частоту возник-новения нефропатии на 25%, ретинопатии -на 39% [13]. Как показывают расчеты, доведение обеспечения тест-полосками больных СД, получающих инсулиноте-рапию, до нормативного показателя позволило бы по-тенциально снизить уровень HbA 1c на 0,6%.…”

“…По данным O.Schnell и коллег, снижение погрешности глюкометра и тест-полосок с 20% до 15%, с 20% до 10% и с 20% до 5% приводит к снижению гли-кированного гемоглобина соответственно на 0,14%, 0,28% и 0,39% [14,15]. Данные этих и ранее упомянутых исследований, определяющих количественные связи между снижением уровня гликированного гемоглобина и клиническими исходами СД [16,17], были положены в основу расчета потенциальных экономических выгод от закупок в рамках государственно финансируемых про-грамм борьбы с СД средств проведения самоконтроля уровня глюкозы крови с низкой погрешностью измере-ния. Как показали расчеты, в российских условиях по-тенциальное снижение погрешности глюкометров может привести к значительным экономическим выгодам, су-щественно сокращая экономическое бремя СД за счет улучшения состояния здоровья больных СД, получаю-щих инсулинотерапию.…”

Accuracy and Precision of Measured Blood Sugar Values by Three Glucometers Compared to the Standard Technique

“…SMBG is a process of Blood Glucose (BG) checking by the patient himself, employing a glucometer device. It leads to increasing the participation of patients in their therapeutic process, as the result, promoting the quality of life through increasing their self-confidence [9,10]. According to the American Diabetes Association, SMBG commonly applied three times a day [11].…”