Blood glucose monitoring
Blood glucose levels are one of the clinical parameters which can be used to monitor the effectiveness of diabetes management. People with diabetes are able to perform this procedure at home and need to have the necessary information to be able to respond to the results they record.
It is important for people with diabetes to aim to achieve the best possible glycaemic control and blood pressure at all times. Two major research studies undertaken to discover the evidence base for the need to achieve as near normal blood glucose levels, and as near normal blood glucose levels and blood pressure are the DCCT for people with type 1 diabetes (Diabetes Control and Complications Trial 1993), and the UKPDS for people with type 2 (United Kingdom Prospective Diabetes Study Group 1998) respectively. The research has shown that there is correlation between HbA1C levels above 7% and development and progression of the complications associated with diabetes. Debates continue over the potential harm of intensive blood glucose control in people with type 2 diabetes. There are references to this in the resources listed below.
Advantages of blood glucose monitoring are:
- to identify hypoglycaemia (low blood glucose level)
- to identify hyperglycaemia (high blood glucose level)
- to check whether treatment is effective
- to encourage independence and self-care.
Disadvantages:
- poor technique may lead to sore fingers and unreliable results
- abnormal results may be obtained if meter fails
- anxiety over results
- cost of equipment
- can be socially embarrassing
- safe disposal of sharps may be difficult when outside the hospital.
References
Full details of the bracketed citations in the text above and, in many cases, links to the actual documents are available in the reference list within this resource. Go to the Reference list.
Resources
You will find here links to evidence-based resources which support this topic. You may also wish to refer to information about the national service frameworks and strategies across the UK.
Some of the resources on this page are in PDF format - see how to access PDF files.
Guidelines and guidance
Diabetes UK (2008) Position statement: Continuous glucose monitoring
This position statement describes different systems for Continuous glucose monitoring (CGM), how CGM works and where it is useful.
Diabetes UK (2009) Position statement: Self-monitoring of blood glucose
In this statement, Diabetes UK provides a rationale for access to self-monitoring of blood glucose (SMBG), and outlines the debate around routine SMBG in relation to clinical and cost effectiveness.
NICE (2009) Type 2 diabetes - newer agents (partial update of CG66)
The advice in this new guideline (CG87) includes the monitoring of glucose, lipid (blood cholesterol and fat) and blood pressure levels, and the use of medications in relation to these.
Systematic reviews and evidence summaries
Bandolier: Internet diabetes monitoring
Summarises a randomised trial on using the Internet for monitoring type 2 diabetes.
Bandolier: SMBG in type 2 diabetes
Summarises a long-term study which points to better clinical outcomes with self-monitoring of blood glucose (SMBG).
BMJ: Efficacy of self monitoring of blood glucose in patients with newly diagnosed Type 2 diabetes (ESMON study): randomised controlled trial
This research study concludes " In patients with newly diagnosed type 2 diabetes self monitoring of blood glucose concentration has no effect on glycaemic control but is associated with higher scores on a depression subscale".
BMJ: Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial
This study concludes "Self monitoring of blood glucose with or without additional training in incorporating the results into self care was associated with higher costs and lower quality of life in patients with non-insulin treated type 2 diabetes".
For more information about Cochrane Systematic Reviews, an example of which appears below, visit the page within this resource on the Cochrane Library.
Cochrane Review: Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus
The authors summarise the results of this systematic review published in 2011 as follows: “We could not find any significant reduction in either death from any cause or death from heart disease when targeting intensive glycaemic control compared with conventional control. Intensive glycaemic control, however, reduced the risk of amputation of a lower extremity and of microvascular complications while increasing the risk of hypoglycaemia. Targeting intensive glycaemic control did not appear to change the risk of macrovascular complications as a composite outcome (an outcome consisting of several items with importance to macrovascular complications), non-fatal stroke, cardiac revascularization (a procedure to reconstruct damaged heart blood vessels), and peripheral revascularization. In trials exclusively dealing with glycaemic control in the usual care setting, a significant reduction in non-fatal myocardial infarction, in favour of targeting intensive glycaemic control, was shown. However, more trials are needed before firm evidence is established”. See also:
National Prescribing Centre MeRec Rapid Review (2011) Cochrane review suggests cautious approach when reducing blood glucose in type 2 diabetes
This comments on the review and its findings.
Cochrane Review: Self-monitoring of blood glucose in patients with type 2 diabetes who are not using insulin
The review aimed to assess the effects of self-monitoring of blood glucose (SMBG) in people with type 2 diabetes mellitus who are not using insulin. The authors concluded that self-monitoring of blood glucose might be effective in improving glycaemic control in patients with type 2 diabetes who are not using insulin but recommended that a long term trial to assess the potential benefits.
National Institute for Health Research Health Technology Assessment programme (NIHR HTA) (2010) Self-monitoring of blood glucose in type 2 diabetes
The study reports that "self-monitoring of blood glucose is of limited clinical effectiveness in improving glycaemic control in patients with type 2 diabetes who are being treated with oral agents, or diet alone, and is therefore unlikely to be cost-effective”.
National Prescribing Centre (2011) MeReC Bulletin 21(5) June: Improving outcomes in type 2 diabetes
Looks at the priorities for management of type 2 diabetes and the issues around controlling blood glucose level.
National Prescribing Centre MeRec Monthly no 25 April 2010: Blood glucose lowering and mortality in type 2 diabetes: not too little, not too much
Looks at the findings from a large retrospective cohort study which supports the findings of RCTs that in patients with type 2 diabetes intensive blood glucose control may increase the risk of harm. “This study found an association between increased all-cause mortality above and below an HbA1c level of about 7.5% (59mmol/mol). Intensifying treatment with insulin was associated with a greater risk of these events than intensifying treatment with oral hypoglycaemic agents”.
NICE Pathways: Diabetes overview
NICE Pathways is an online tool for health and social care professionals that brings together all related NICE guidance and associated products in a set of interactive topic-based diagrams. One of the topic areas is on Blood-glucose-lowering therapy for type 2 diabetes .
Other resources
RCN Diabetes Nursing Forum (2009) HbA1c - The new numbers are starting now!
This feature which appears in the Forum community pages and was written by Mags Bannister, Chair of the Forum, describes the new HbA1c reporting method which was introduced in June 2009.
There are separate resources lists for other specific aspects of treatment and lifestyle - see Treatment and lifestyle topics.