What is the role of self-monitoring of blood glucose (SMBG) in type 2 diabetes mellitus (DM)?

Updated: Sep 27, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

Daily SMBG is important for patients treated with insulin or insulin secretagogues to monitor for and prevent hypoglycemia, as well as to optimize the treatment regimen. The optimal frequency of SMBG for patients with type 2 diabetes is unresolved, but it should be sufficient to facilitate reaching glucose goals.

The author often utilizes no or minimal SMBG in patients using lifestyle changes alone or agents that do not cause hypoglycemia (eg, metformin, TZDs, glucosidase inhibitors). Patients using multiple insulin injections should use SMBG at least 3 times a day. [2]

A task force from the Endocrine Society evaluated the following potential uses for continuous glucose monitoring:

  • Real-time, continuous glucose monitoring in adults in hospital settings

  • Real-time outpatient monitoring in children and adolescents

  • Real-time outpatient monitoring in adults

The Task Force developed recommendations regarding benefits in maintaining target levels of glycemia and limiting the risk of hypoglycemia. [300]

Although other continuous glucose monitors (CGMs) are aimed at persons with type 1 diabetes, a model has been developed specifically for persons with type 2 diabetes who are not at high risk for hypoglycemia, as well as for those with prediabetes. The device, called SugarBEAT (Nemaura Medical; Loughborough, UK), is noninvasive, using an adhesive patch and sensor and drawing glucose molecules from the interstitial fluid just beneath the skin’s surface for measurement. A Bluetooth connection is employed to transmit data every 5 minutes to a smartphone app. The device is worn for 14 hours at a time during the day and for just 2-4 days monthly (in contrast to CGMs for patients with type 2 diabetes, which are utilized every day). Although SugarBEAT is noninvasive, a once-daily fingerstick is still needed for calibration. In May 2019, it received a CE (Conformité Européenne) Mark in Europe for use as a Class IIb medical device. Although still awaiting FDA approval in the United States, permission has in the meantime been granted for this CGM to be marketed as a “wellness” device, with SugarBEAT in this capacity producing retroactive reports for the physician and patient rather than real-time values. [301]


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