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      Self-Monitoring of Blood Glucose as an Integral Part in the Management of People with Type 2 Diabetes Mellitus

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          Abstract

          For decades, self-monitoring of blood glucose (SMBG) has been considered a cornerstone of adequate diabetes management. Structured SMBG can follow different monitoring patterns, and it results in improved glycemic control, reduced hypoglycemia, and a better quality of life of people with diabetes. The technology, usability, and accuracy of SMBG systems have advanced markedly since their introduction a few decades ago. Current SMBG systems are small and easy to use, require small (capillary) blood sample volumes, and provide measurement results within seconds. In addition, devices are increasingly equipped with features such as connectivity to other devices and/or digital diaries and diabetes management tools. Although measurement quality can come close to or equal that of the glucose monitoring systems used by healthcare professionals, several available SMBG systems still do not meet internationally accepted accuracy standards, such as the International Organization for Standardization 15197 standard. Reports from China, India, and Brazil based on local experience suggest that in addition of the accuracy issues of SMBG systems, other obstacles also need to be overcome to optimize SMBG usage. Nonetheless, adequate usage of SMBG data is of high relevance for the management of people with type 2 diabetes mellitus.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s13300-022-01254-8.

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          The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus

          S Genuth, C. Siebert, D. M. Nathan … (1993)
          Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications. A total of 1441 patients with IDDM--726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly. In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of > or = 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of > or = 300 mg per 24 hours) by 54 percent (95 percent confidence interval 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia. Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.
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            Understanding Bland Altman analysis

            Davide Giavarina (2015)
            In a contemporary clinical laboratory it is very common to have to assess the agreement between two quantitative methods of measurement. The correct statistical approach to assess this degree of agreement is not obvious. Correlation and regression studies are frequently proposed. However, correlation studies the relationship between one variable and another, not the differences, and it is not recommended as a method for assessing the comparability between methods.
In 1983 Altman and Bland (B&A) proposed an alternative analysis, based on the quantification of the agreement between two quantitative measurements by studying the mean difference and constructing limits of agreement.
The B&A plot analysis is a simple way to evaluate a bias between the mean differences, and to estimate an agreement interval, within which 95% of the differences of the second method, compared to the first one, fall. Data can be analyzed both as unit differences plot and as percentage differences plot.
The B&A plot method only defines the intervals of agreements, it does not say whether those limits are acceptable or not. Acceptable limits must be defined a priori, based on clinical necessity, biological considerations or other goals.
The aim of this article is to provide guidance on the use and interpretation of Bland Altman analysis in method comparison studies.
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              Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013.

              Limin Wang, Pei Gao, Mei Zhang … (2017)
              Previous studies have shown increasing prevalence of diabetes in China, which now has the world's largest diabetes epidemic.
              Article 0 comments Cited 534 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Rolf Hinzmann:
                ORCID: http://orcid.org/0000-0002-8419-4740
                rolf.hinzmann@roche.com
                Journal
                Journal ID (nlm-ta): Diabetes Ther
                Journal ID (iso-abbrev): Diabetes Ther
                Title: Diabetes Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 1869-6953
                ISSN (Electronic): 1869-6961
                Publication date (Electronic): 13 April 2022
                Publication date PMC-release: 13 April 2022
                Publication date (Print): May 2022
                Volume: 13
                Issue: 5
                Pages: 829-846
                Affiliations
                [1 ]GRID grid.6582.9, ISNI 0000 0004 1936 9748, Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, ; Ulm, Germany
                [2 ]Science Consulting in Diabetes GmbH, Kaarst, Germany
                [3 ]Diabetes Clinic for Children and Adolescents, Muenster, Germany
                [4 ]GRID grid.411634.5, ISNI 0000 0004 0632 4559, Peking University People’s Hospital, ; Peking, China
                [5 ]GRID grid.410867.c, ISNI 0000 0004 1805 2183, Dr. Mohan’s Diabetes Specialities Centre, ; Chennai, India
                [6 ]GRID grid.429336.9, ISNI 0000 0004 1794 3718, Madras Diabetes Research Foundation, ; Chennai, India
                [7 ]Pediatric Endocrine Unit, Pediatric Department, Santa Casa School of Medical Department, Santa Casa School of Medical Sciences, Sao Paulo, Brazil
                [8 ]GRID grid.424277.0, Roche Diabetes Care GmbH, ; Sandhofer Straße 116, 68305 Mannheim, Germany
                Author information
                http://orcid.org/0000-0003-4629-7754
                http://orcid.org/0000-0002-0406-9529
                http://orcid.org/0000-0002-9873-0989
                http://orcid.org/0000-0003-2493-1304
                http://orcid.org/0000-0002-2373-3720
                http://orcid.org/0000-0003-1305-1598
                http://orcid.org/0000-0001-5038-6210
                http://orcid.org/0000-0003-2085-5316
                http://orcid.org/0000-0002-8419-4740
                Article
                Publisher ID: 1254
                DOI: 10.1007/s13300-022-01254-8
                PMC ID: 9076772
                PubMed ID: 35416589
                SO-VID: 7e4a9bc9-2006-4051-84ec-0da1e88acc51
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 18 February 2022
                Date accepted : 14 March 2022
                Funding
                Funded by: Roche Diabetes Care GmbH
                Categories
                Subject: Commentary
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: self-monitoring of blood glucose,type 2 diabetes mellitus,blood glucose monitoring systems,accuracy,diabetes management
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: self-monitoring of blood glucose, type 2 diabetes mellitus, blood glucose monitoring systems, accuracy, diabetes management

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