Patient self-monitoring

  • Hannelore Rott
  • Theodor Koschinsky


The technical advances made in terms of simpler and faster glucose monitoring systems confer significant benefit in the daily lives of patients suffering from diabetes. Additional requirements must be met in order to prevent the risk of errors arising from the use and interpretation of glucose measurements as well as to enable patients deemed capable to perform self-monitoring. Two main test system principles are available to patients with diabetes mellitus to help them control their glucose metabolism: Self-monitoring of urine and of blood glucose levels. The standard procedure is to measure blood glucose in fresh capillary blood, usually taken as a single specimen from the fingertip or earlobe. Additionally, devices for continuous blood glucose monitoring that rely on needle sensors are available. Such meters monitor glucose in the subcutaneous interstitial fluid and convert it into blood glucose equivalents.Patient self-management in vitamin K antagonist treatment requires regular INR monitoring, usually once per week. INR testing by the patients themselves at the point of care leads to significant improvements in clinical outcome and quality of life. Especially a significant reduction in the number of deaths on vitamin K antagonist treatment has been shown. By definition, INR is 1.0 in individuals with normal coagulation. Treatment with vitamin K antagonists causes higher values. Depending on diagnosis, e.g. thromboembolism, atrial fibrillation and heart valve replacement, the target INR nowadays has a target range of 2.0–3.0 in most cases.


  1. 1.
    Azarnoush K, Camilleri L, Aublet-Cuvelier B, et al. (2011) Results of the first randomized French study evaluating self testing of the International Normalized Ratio. J Heart Valve Dis 20(5):518–525Google Scholar
  2. 2.
    Barthels M, Bergmann F (2016) Global- und Gruppentests. In: Barthels M (ed) Das Gerinnungskompendium. 2nd ed. Thieme, Stuttgart New York, p 359–370Google Scholar
  3. 3.
    Baumstark A, Pleus S, Schmid C et al. (2012) Lot-to-lot variability of test strips and accuracy assessment of systems or self-monitoring of blood glucose according to ISO 15197. J Diabetes Sci Technol 6:1076–1086CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Dauphin C, Legault B, Jaffeux P, et al. (2008) Comparison of INR stability between self-monitoring and standard laboratory method: preliminary results of a prospective study in 67 mechanical heart valve patients. Arch Cardiovasc Dis 101 (11–12):753–761CrossRefPubMedGoogle Scholar
  5. 5.
    Deutsche Diabetes Gesellschaft (2015) Praxisempfehlungen: Therapie des Typ-1-Diabetes. Diabetologie 10 (Suppl 2) S129–S139Google Scholar
  6. 6.
    Deutsche Diabetes Gesellschaft (2015) Praxisempfehlungen: Therapie des Typ-2-Diabetes. Diabetologie 10 (Suppl 2) S140-S151Google Scholar
  7. 7.
    Deutschen Diabetes Gesellschaft (2016) Stellungnahme 11 February 2016: Notwendigkeit der Desinfektion der Haut vor der Kapillar-Blutgewinnung für die Glukosemessung im Krankenhaus.
  8. 8.
    DIN German Institute for Standardization (2015) In vitro diagnostic test systems – Requirements for blood-glucose monitoring systems for self-testing in managing diabetes mellitus (ISO 15197:2013); English Version DIN EN ISO 15197:2015Google Scholar
  9. 9.
    Freckmann G, Schmid C, Baumstark A et al. (2012) System accuracy evaluation of 43 blood glucose monitoring systems for self-monitoring of blood glucose according to DIN EN ISO 15197. J Diabetes Sci Technol 6:1060–1075CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Freckmann G, Link M, Schmid C et al. (2015) System accuracy evaluation of different blood glucose monitoring systems following ISO 15197:2013 by using two different comparison methods. Diabetes Technol Ther 17:635–648CrossRefGoogle Scholar
  11. 11.
    Freckmann G (2016) Patientensicherheit bei der Blutzuckermessung. Thieme Praxis Report 8 (3): 1–20Google Scholar
  12. 12.
    Heneghan C, Alonso-Coello P, Garcia-Alamino JM, Perera R, Meats E, Glasziou P (2006) Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet 367(9508):404–411CrossRefGoogle Scholar
  13. 13.
    Hentrich DP, Fritschi J, Muller PR, Wuillemin WA (2007) INR comparison between the CoaguChek S and a standard laboratory method among patients with self-management of oral anticoagulation. Thrombosis Research 119(4):489–495CrossRefPubMedGoogle Scholar
  14. 14.
    Ryan F, O’Shea S, Byrne S (2010) The reliability of point-of-care prothrombin time testing. A comparison of CoaguChek S and XS INR measurements with hospital laboratory monitoring. Int J Lab Hematol 32 (1 Pt 1):e26–e33CrossRefPubMedGoogle Scholar
  15. 15.
    Scandinavian evaluation of laboratory equipment for primary health care (SKUP):
  16. 16.
    Siebenhofer A, Berghold A, Sawicki PT (2004) Systematic review of studies of self-management of oral anticoagulation. Thromb Haemost 91(2): 225–232Google Scholar
  17. 17.
    Torreiro EG, Fernandez EG, Rodriguez RM, Lopez CV, Nunez JB (2009) Comparative study of accuracy and clinical agreement of the CoaguChek XS portable device versus standard laboratory practice in unexperienced patients. Thromb Haemost 101(5):969–974CrossRefPubMedGoogle Scholar
  18. 18.
    Verband der Diabetes-Beratungs- und Schulungsberufe in Deutschland e.V.(VDBD) (2014) Leitfaden zur Blutzucker-Selbstkontrolle in Beratung und Therapie 2–39; EigenverlagGoogle Scholar
  19. 19.
    WHO Expert Committee on Biological Standardization (1983) Thirty-third report. World Health Organ Tech Rep Ser 687:1–184Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hannelore Rott
    • 1
  • Theodor Koschinsky
    • 2
  1. 1.Gerinnungszentrum Rhein-RuhrDuisburgGermany
  2. 2.Vertreter der Deutschen Diabetes GesellschaftMünchenGermany

Personalised recommendations