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QUICK REFERENCE GUIDE TO DIABETES FOR HEALTH CARE PROVIDERS

Chapter 11
Self Monitoring of Blood Glucose (SMBG)

Self-monitoring of blood glucose (SMBG) allows persons with diabetes to evaluate their individual response to therapy and assess whether glycemic targets are being met. Results of SMBG can be useful in preventing hypoglycemia and adjusting medications, medical nutrition therapy (MNT) and physical activity. The frequency and timing of SMBG should be determined by individual needs and goals of each person with diabetes.

• SMBG should be carried out three or more times daily in those with type 1 diabetes, pregnant women using insulin and those on multiple insulin injections.
• For those using less frequent insulin injections or oral agents or MNT alone, SMBG is useful in achieving glycemic goals.
• Postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial glucose goals.
• Persons with diabetes should be routinely evaluated to assess their technique and ability to use data to adjust therapy.
  

Another test of glycemic control is the A1C test, which measures the average blood glucose control over the past 2-3 months. See table below for the correlation between A1C level and mean plasma glucose.

A1C is the primary target for glycemic control and should be checked routinely in all persons with diabetes:

• at least two times a year in those with stable glycemic control.
• quarterly in those whose therapy has changed or who are not meeting glycemic goals.

Blood glucose and A1C goals must be individualized based on age, ability to recognize hypoglycemia, history of hypoglycemia and self-management capabilities. This is especially important for children, adolescents, pregnant women and older adults. More stringent goals (A1C <6%) may further reduce complications at the cost of increased risk of hypoglycemia, especially in those with type 1 diabetes. Less stringent goals are be indicated in those with severe or frequent hypoglycemia. See table below for target blood glucose and A1C goals for persons with diabetes.

Target Glycemic Goals for Persons with Diabetes

* American Diabetes Association
** American Association of Clinical Endoc

References: American Diabetes Association (2003). Clinical Practice Recommendations, 2003. Diabetes Care, Vol 26 (1).