Real-world use of self-monitoring of blood glucose in people with type 2 diabetes: an urgent need for improvement
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To assess use of self-monitoring of blood glucose (SMBG) in type 2 diabetes (T2DM) in the context of a continuous quality improvement initiative (AMD Annals).
14 quality-of-care indicators were developed, including frequency of SMBG, fasting blood glucose (FBG), and post-prandial glucose (PPG) levels, and hypoglycemia and hyperglycemia episodes. Clinical data and SMBG values downloaded from any glucose meter were obtained from electronic medical records. The most frequently used glucose-lowering treatment regimens were identified and the indicators were assessed separately by regimen.
Overall, 21 Italian centers and 13,331 patients (accounting for 35,657 HbA1c tests and 8.44 million SMBG values collected during 2014 and 2015) were included in the analysis; 11 therapeutic regimens were selected. Patients in regimens not including insulin performed 15–23 measurements per patient-month, those treated with basal insulin 32.1 tests/patient-month, and those treated with basal and short-acting insulin 53–58 tests/patient-month. In all treatment regimens, PPG measurements represented a minority of all tests; pre-breakfast measurements accounted for about 50% of all FBG values. Mean FBG levels exceeded 130 mg/dl in 49.3–88.3% of the cases in the different treatment regimens, while PPG levels were over 140 mg/dl in 46.7–81.0%. From 5.7 to 32.7%, patients in the different regimens had at least one episode of hypoglycemia (< 70 mg/dl), while from 3.7 to 47.7% had at least one episode of hyperglycemia (> 300 mg/dl).
SMBG is underutilized in patients with T2DM treated or not with insulin. In all treatment groups, PPG is seldom investigated. Poor metabolic control and rates of hyper- and hypoglycemia deserve consideration in all treatment groups.
KeywordsSelf-monitoring blood glucose Type 2 diabetes Quality of care Benchmarking Adherence
American Diabetes Association
Associazione Medici Diabetologi
Dipeptidyl peptidase-4 inhibitor
European Association for the Study of Diabetes
Electronic medical record
Fasting blood glucose
Glucagon-like peptide-1 receptor agonists
International Diabetes Federation
Oral hypoglycemic agent
Self-monitoring blood glucose
Type 2 diabetes
- 95% CI
95% confidence interval
The study was promoted by the AMD scientific society through an unconditional Grant by Sanofi SpA, Milan, Italy. The authors thank the participating diabetes outpatient centers for their contribution. The authors acknowledge Sanofi—Italy for having supported this work. The sponsor did not participate in the design or conduct of this study; in the collection, management, analysis, or interpretation of data; in the writing of the manuscript; and in the preparation, review, approval, or decision to submit this manuscript for publication. AMD ANNALS-SMBG Study Group list of investigators: Nuzzi Annamaria—Alba, Canale (CN), Velussi Mario—Aurisina (TS), Spanu Francesca—Cagliari, Del Buono Andrea—Cellole (CE), Santantonio Graziano—Civitavecchia (RM), Magro Giampaolo—Cuneo, Garrapa Gabriella—Fano (PU), Antenucci Daniela—Lanciano (CH), Laudato Mario—Maddaloni (CE), Saitta Giovanni—Messina, Stroppiana Mauro—Nizza Monferrato (AT), D’Agati Francesco—Palermo, Anichini Roberto—Pescia (PT), Di Bartolo Paolo—Ravenna, Rastelli Emilio—Riccione (RN), Leotta Sergio—Roma, Felace Giuseppe—Spilimbergo (PN), Lalli Carlo—Spoleto (PG), Tonutti Laura—Udine.
The study was supported by a unconditional Grant from Sanofi SpA, Milan, Italy.
Compliance with ethical standards
Conflict of interest
The author(s) declare that they have no competing interests.
Statement of human and animal rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Statement of informed consent
Based on the study design and Italian regulations, the study protocol was approved by the local Ethics Committees and the signed informed consent was not required.
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