Pattern management: A four-step approach to better outcomes

Pattern management is the systematic interpretation of self-monitored blood glucose (SMBG) results and contextual data over time to help you and your patients identify glycaemic deviations. Using patterns identified in SMBG data to identify potential therapy changes can improve your patients’ overall glycaemic control1,2.

Doctor with patient showing information on a tablet

Following this four-step approach to pattern management could help you to ensure you are focusing on the right areas:

1. Identify the out-of-range results

Use the patient's SMBG data to identify all out-of-range results:

  • First, look for any hypoglycaemic events
  • Secondly, focus on fasting or preprandial hyperglycaemia; prioritise fasting results above the target range, then assess any preprandial hyperglycaemia
  • Thirdly, look at any postprandial hyperglycaemic episodes, specifically values more than 2.8 mmol/L (50 mg/dL) higher than the related preprandial values

2. Determine timing and frequency

Two or more episodes in any of the areas mentioned above indicate an out-of-range result that must be treated.

3. Look into causes

Talk with your patient about the patterns you have identified. Ask if they did anything around those times that could have affected their glucose levels. These conversations are your opportunity to help them better understand the direct connection between food, exercise, or behaviour choices and glycaemic management.

4. Take action

Address one area at a time. If a patient has more than one area of focus, address the most significant one first (e.g. concentrate on hypoglycaemia before hyperglycaemia). Base your therapy recommendations on their SMBG data and your discussion of glucose-impacting behaviours.

  1. Polonsky WH et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study. Diabetes Care. 2011;34:262-7.
  2. Pearson J, Bergenstal R. Fine-tuning control: pattern management versus supplementation. Diabetes Spectrum. 2001;14:75–8.

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