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Structured monitoring - or self-monitoring of blood glucose (SMBG) with a plan and a purpose - can take different forms and can be extremely useful in influencing patient behaviour. It not only gives your patients periodic updates on their blood glucose levels, but also provides data that can inform conversations to maximise therapy outcomes.
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National and international diabetes organisations view structured SMBG as a valuable supplementary tool for recording the acute and intra-day details behind three-month HbA1c measurements. However, healthcare professional-to-patient communication and a clear understanding of the goal and therapeutic element being addressed is a vital component of success.
According to the International Diabetes Federation’s Guideline for Self-Monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes, communication and intent are key to structured monitoring1:
| SMBG examples | Purpose | Action |
|---|---|---|
| Pattern testing | <ul><li>Issue identification</li><li>Education or awareness</li><li>Engagement; unbiased motivator for diabetes self-management</li></ul> | <ul><li>Therapy adjustment</li><li>Behaviour change</li></ul> |
| Paired testing | <ul><li>Education or awareness</li><li>Engagement; self-management</li><li>Bolus calculation</li><li>Bolus type/frequency in pump therapy</li></ul> | <ul><li>Therapy adjustment</li><li>Behaviour change</li></ul> |
| Titration testing | <ul><li>Insulin regime: total daily dose (TDD), bolus/basal doses</li><li>Bolus type/frequency in pump therapy</li></ul> | <ul><li>Therapy adjustment</li></ul> |
| SMBG examples | Purpose | Action |
|---|---|---|
| Insulin management testing | Insulin regime: TDD, bolus/basal doses | Adjust dosage, timing, or insulin type |
| Lifestyle intervention testing | Glycaemic management in non-insulin requiring people with diabetes | Behaviour change: activity, stress, schedule, diet, snacking, alcohol |
| Monitoring regime | Description | Application |
|---|---|---|
| Staggered profile | Pre- and postprandial BG measurements for one meal per day or overnight | Staggering mealtimes provides more data and a clearer picture of glucose levels and patterns |
| 7-point profile | Pre- and postprandial BG measurements for three meals per day and bedtime BG for a short time period, such as three consecutive days | For an overall assessment of the glucose profile, such as before a clinical visit |
| Paired testing | Pre- and postprandial BG measurements for the same meal (breakfast, lunch, or dinner) on seven consecutive days | Specific mealtime data for evaluation of postprandial glucose excursions; can support identification of the need for additional medications or therapy changes to target postprandial hyperglycaemia |
Additional sources:
Di Molfetta S, Bosi E, Ceriello A, Cucinotta D, Tiengo A, Scavini M, Piccolo C, Bonizzoni E, Acmet E, Giorgino F; PRISMA STUDY GROUP. Structured self-monitoring of blood glucose is associated with more appropriate therapeutic interventions than unstructured self-monitoring: a novel analysis of data from PRISMA. Diabetes Res Clin Pract. 2021 Sep 27;109070. doi: 10.1016/j.diabres.2021.109070
Russo GT, Scavini M, Acmet E, Bonizzoni E, Bosi E, Giorgino F, Tiengo A, Cucinotta D. The Burden of Structured Self-Monitoring of Blood Glucose on Diabetes-Specific Quality of Life and Locus of Control in Patients with Noninsulin-Treated Type 2 Diabetes: The PRISMA Study. Diabetes Technol Ther. 2016 Jul;18(7):421-8. doi:10.1089/dia.2015.0358. Epub 2016 Jun 21.
Scavini M, Bosi E, Ceriello A, Giorgino F, Porta M, Tiengo A, Vespasiani G, Bottalico D, Marino R, Parkin C, Bonizzoni E, Cucinotta D. Prospective, randomized trial on intensive SMBG management added value in non-insulin-treated T2DM patients (PRISMA): a study to determine the effect of a structured SMBG intervention. Acta Diabetol. 2013 Oct;50(5):663-72. doi: 10.1007/s00592-011-0357-y.
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