Value and utility of structured self-monitoring of blood glucose in real world clinical practice: findings from a multinational observational study

Comparative effectiveness of telemonitoring versus usual care for type 2 diabetes: A systematic review and meta-analysis

AIMS

This study evaluated clinical effectiveness of telemonitoring on the management of patients with type 2 diabetes.

METHODS

We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane Library to identify randomized controlled trials that compared telemonitoring and usual care in patients with type 2 diabetes.

RESULTS

Thirty-eight studies (6855 patients) were included. Telemonitoring was associated with a significant decrease in glycated haemoglobin levels compared to usual care (weighted mean difference -0.42%, 95% confidence interval -0.56 to -0.27) but there was evidence of heterogeneity (I²= 96.9%). Telemonitoring was associated with a significant glycated haemoglobin reduction when biological data were transmitted through a web-based device weekly, when voice feedback was performed daily or immediately and when patients were provided with counselling. Telemonitoring also reduced glycated haemoglobin level in studies that monitored patients' medication adherence, provided counselling, education and alarm message. The rate of achieving glycated haemoglobin levels of < 7% was 1.8 times higher in the telemonitoring group compared to the usual care group (risk ratio 1.83, 95% confidence interval 1.35 to 2.47, I²= 0%). There was also significant reduction in systolic blood pressure (weighted mean difference -1.33 mm Hg) and body mass index (weighted mean difference -0.25 kg/m²), but the clinical relevance of these results can be questioned. The data available on patient satisfaction, quality of life, medication adherence, prescription changes, stress and depression were limited.

CONCLUSIONS

Telemonitoring interventions may be a better option than usual care in improving glycated haemoglobin control of patients with type 2 diabetes. Further studies should assess clinical benefit according to specific delivery modes of the intervention and patient-reported outcomes.

The Impact of Structured Self-Monitoring of Blood Glucose Combined With Intensive Education on HbA1c Levels, Hospitalizations, and Quality-of-Life Parameters in Insulin-Treated Patients With Diabetes at Primary Care in Serbia: The Multicenter SPA-EDU Study

BACKGROUND

We assessed the effect of structured self-monitoring of blood glucose (SMBG), in combination with intensive education, on metabolic control, SMBG frequency, hospitalizations, cardiovascular risk factors, and quality-of-life parameters in patients with insulin-treated diabetes in primary health care settings in Serbia.

METHODS

This 6-month, observational, noninterventional study, followed 346 insulin-treated diabetes patients (type 1 diabetes [T1D], n = 57; type 2 diabetes [T2D], n = 289) from 28 primary care centers. Patients attended a 10-day course at the specialized educational center and were followed monthly by their primary care physicians. Patients used a simple paper tool to document 3-day, 7-point glucose profiles prior to each monthly clinic visit. Physicians reviewed the completed forms at each visit and used a standardized education program to provide remedial training. Changes in HbA1c levels, SMBG frequency, metabolic risk factors, and Diabetes Distress Scale (DDS) were assessed.

RESULTS

Mean (± SD) HbA1c within the full cohort was significantly improved from baseline at 6 months (8.85 ± 1.17% vs 7.91 ± 1.24%, P < .01). Significant increases in average SMBG frequency per week were seen at 6 months versus baseline (14.6/week vs 4.3/week, P < .001). The mean (± SE) number of hospitalizations due to metabolic conditions was significantly lower during the 6-month study compared to the 6-month period prior to the study (0.14 ± 0.04 vs 0.59 ± 0.09). DDS scores decreased from 39.6 ± 13.9 to 33.9 ± 14.5, P < .01.

CONCLUSION

The use of structured SMBG combined with intensive education was associated with clinically significant reductions in HbA1c, increased SMBG frequency, and improved quality of life.

Does availability of reliable home blood glucose data at diabetes appointments improve glycemia?

OBJECTIVE

To establish the prevalence of reliable self-monitored blood glucose (r-SMBG) data at office visits for diabetes and to determine whether r-SMBG is associated with changes in glycemic control and other clinical parameters.

METHODS

We conducted a chart review of 500 patients followed in an Endocrinology Faculty/Commercial Insurance Practice (FP) or a Managed Medicare/Medicaid Diabetes Clinic (MDC). Follow-up visits for patients with type 1 or type 2 diabetes from January 1, 2012 to June 30, 2012 were analyzed for anthropometric data, creatinine (Cr), glomerular filtration rate (GFR), low-density lipoprotein cholesterol (LDL-C), medications, hemoglobin A1C (A1C), change in A1C from the previous visit (ΔA1C), and availability of r-SMBG data at the visit.

RESULTS

Our sample was composed of 215 MDC patients (43%) and 285 FP patients (57%). Overall, 151 patients (30%) provided r-SMBG data at their visit, with no difference between MDC or FP patients. Mean A1C at MDC was 9.1%, while mean A1C at FP was 7.9% (P<.001). MDC patients with A1C >8.0% demonstrated an A1C reduction of 1.2% if they provided r-SMBG, compared to an increase of 0.1% for MDC patients who did not (P<.05). Providing r-SMBG did not affect A1C in FP patients in any A1C range.

CONCLUSION

Only a minority of diabetes patients, mostly insulin-treated, made r-SMBG data available to their providers. Insulin-requiring Managed Medicare/Medicaid patients with poorly controlled diabetes had an A1c reduction associated with r-SMBG. Prospective studies are needed to determine whether this patient population may be more likely to benefit from r-SMBG at their visits.

8th Annual Symposium on Self-Monitoring of Blood Glucose (SMBG): April 16-18, 2015, Republic of Malta

International experts in the fields of diabetes, diabetes technology, endocrinology, mobile health, sport science, and regulatory issues gathered for the 8(th) Annual Symposium on Self-Monitoring of Blood Glucose (SMBG) with a focus on personalized diabetes management. The aim of this meeting was to facilitate new collaborations and research projects to improve the lives of people with diabetes. The 2015 meeting comprised a comprehensive scientific program, parallel interactive workshops, and two keynote lectures.

Improving the Quality of Outpatient Diabetes Care Using an Information Management System: Results From the Observational VISION Study

BACKGROUND

This study aimed to evaluate the effects of information management system (IMS) use with individuals with type 1 and type 2 diabetes who were treated in outpatient settings.

METHODS

In this 7-month, prospective, observational study, 965 adults with diabetes, mean (SD) baseline HbA1c 8.61(1.2)% (70.6[13.1] mmol/mol), were recruited from 132 outpatient care centers in Germany and Denmark. HbA1c was measured at baseline, month 4, and month 7. IMS reports were generated from uploaded self-monitored blood glucose data and therapy adjustments were documented at months 1 and 4. Hypoglycemic events were documented.

RESULTS

Mean (SD) HbA1c decreased from baseline in type 1 and type 2 diabetes patients at month 4 (-0.61[1.03]% (-6.7[11.3] mmol/mol), n = 213; -0.88[1.22]% (-9.6[13.3] mmol/mol), n = 589, respectively) and month 7 (-0.64[1.02]% (-7.0[11.1] mmol/mol), n = 219; -0.93[1.27]% (-10.2[13.9] mmol/mol), n = 594, respectively), all P < .0001, with no increase in hypoglycemic events. Therapy was adjusted in 106(42.7)% type 1 and 349(52.4)% type 2 diabetes patients at months 1 and 105(42.3)% type 1 and 282(42.3)% type 2 diabetes patients at month 4. Physicians used IMS reports to make therapy adjustments in 90% of patients at month 1 and 86% of patients at month 4.

CONCLUSIONS

Integration of the IMS into outpatient care facilitates significant improvements in glycemic control.

Use of a Combined Blood-Glucose- and ß-Ketone-Measuring Device Improves Glycemic Control in Insulin-Treated Patients With Diabetes: The Gold Plus Study

BACKGROUND

Using self-measurements of blood glucose (SMBG) is daily routine for patients with insulin-treated diabetes, however measuring ß-ketones in blood is not widespread. How the use of a combined device, which can measure both, is accepted in daily routine by patients and will lead to better glycemic control is not well studied.

METHODS

This multicenter, prospective, noninterventional study assessed the impact of routine use of the GlucoMen® LX Plus on patient acceptance, usage and glycemic control among insulin-treated patients with diabetes mellitus type 1 and type 2. A1c and self-reported frequency of SMBG were evaluated at baseline and also postprandial SMBG, ß-ketone measurements, and use of reminders after 3 and 6 months of use. A total of 631 patients, 254 type 1/350 type 2 (27 no type specified), with mean (SD) baseline A1c 8.5% (1.5), age 54.6 (15.6) years, and 47.3% female were studied.

RESULTS

Frequent use of SMBG at baseline led to a higher decrease in A1c at 6 month (V3): -0.3% if SMBG measured up to 1/day versus -0.9% in 4-6/day. Increase of SMBG frequency during the study showed also a negative correlation to A1c, 9.2% at V1 versus 7.6% at V3. Postprandial SMBG was done by 77.7% and ß-ketone measurements by 45.5% of all patients; the reminders were used by 33.4% and led to an increased frequency of SMBG at 6 months.

CONCLUSIONS

A combined device for SMBG and ß-ketone measurements is well accepted by patients with insulin-treated diabetes and can lead through the avoidance or detection of ketoacidosis/increased frequency of SMBG and increased awareness of the patients to an improved glycemic outcome.

Optimizing insulin pump therapy: the potential advantages of using a structured diabetes management program

Use of continuous subcutaneous insulin infusion (CSII) therapy improves glycemic control, reduces hypoglycemia and increases treatment satisfaction in individuals with diabetes. As a number of patient- and clinician-related factors can hinder the effectiveness and optimal usage of CSII therapy, new approaches are needed to address these obstacles. Ceriello and colleagues recently proposed a model of care that incorporates the collaborative use of structured SMBG into a formal approach to personalized diabetes management within all diabetes populations. We adapted this model for use in CSII-treated patients in order to enable the implementation of a workflow structure that enhances patient-physician communication and supports patients' diabetes self-management skills. We recognize that time constraints and current reimbursement policies pose significant challenges to healthcare providers integrating the Personalised Diabetes Management (PDM) process into clinical practice. We believe, however, that the time invested in modifying practice workflow and learning to apply the various steps of the PDM process will be offset by improved workflow and more effective patient consultations. This article describes how to implement PDM into clinical practice as a systematic, standardized process that can optimize CSII therapy.

Use of an integrated strip-free blood glucose monitoring system increases frequency of self-monitoring and improves glycemic control: Results from the ExAct study

Aims

We investigated the impact of using an integrated, strip-free system compared to the use of single-strip systems on testing frequency and glycemic control in individuals with insulin-treated diabetes.

Methods

This multinational, comparative, cluster-randomized, observational study included 311 patients with type 1 and insulin-treated type 2 diabetes who were performing SMBG at suboptimal frequencies. Sites were cluster-randomized to “integrated strip-free” system (EXP group) or any “single-strip” system (CNL group). Testing frequency and HbA1c were measured at baseline, 12 weeks and 24 weeks.

Results

At week 24, the EXP group showed an increase in SMBG frequency from baseline of 4.17 tests/week (95% CI 2.76, 5.58) compared with an increase of 0.53 tests/week (95% CI −0.73, 1.79) among CNL patients, resulting in a between-group difference of 3.63 tests/week (p < 0.0002). Mixed-effects models for repeated measurements (MMRM) controlling for baseline frequency of testing, country and clinical site confirmed a higher SMBG testing frequency in the EXP group compared to the CNL group, with a between-group difference of 2.70 tests/week (p < 0.01). Univariate analysis showed greater HbA1c reductions in the EXP group than CNL group: −0.44% (95% CI −0.59, −0.29) vs. −0.13% (95% CI −0.27, 0.01), respectively, p < 0.0002. MMRM analyses confirmed these HbA1c reductions. A greater percentage of EXP than CNL patients achieved HbA1c reductions of ≥0.5%: 45.1% vs. 29.1%, respectively, p < 0.01.

Conclusions

The use of an integrated, strip-free SMBG system improved testing adherence and was associated with improvements in glycemic control.

Telehealth Remote Monitoring Systematic Review: Structured Self-monitoring of Blood Glucose and Impact on A1C

The aim was to summarize research on telehealth remote patient monitoring interventions that incorporate key elements of structured self-monitoring of blood glucose (SMBG) identified as essential for improving A1C. A systematic review was conducted using the Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and OVID Medline databases with search terms "Telemedicine" AND "Monitoring, Physiologic" AND "Diabetes Mellitus, Type 2." Study selection criteria included original randomized clinical trials evaluating the impact of telehealth remote patient monitoring on A1C among adults with type 2 diabetes and incorporated 1 or more essential elements of SMBG identified by the International Diabetes Federation (patient education, provider education, structured SMBG profile, SMBG goals, feedback, data used to modify treatment, interactive communication or shared decision making). Fifteen studies were included, with interventions ranging from 3 to 12 months (mean 8 months) with sample sizes from 30 to 1665. Key SMBG elements were grouped into 3 categories: education, SMBG protocols, and feedback. Research incorporating 5 of the 7 elements consistently achieved significant A1C improvements between study groups. Interventions using more SMBG elements are associated with an improvement in A1C. Studies with the largest A1C decrease incorporated 6 of the 7 elements and computer decision support. Two studies with 5 of the 7 elements and active medication management achieved significant A1C decreases. Telehealth remote patient monitoring interventions in type 2 diabetes have not included all structured monitoring elements recommended by the IDF. Incorporating more elements of structured SMBG is associated with improved A1C.

Impact of behavioral interventions in the management of adults with type 2 diabetes mellitus

Research on the role of behavior change as an efficacious intervention for adults with type 2 diabetes is evolving. Searching PubMed and Ovid Medline, we identified and reviewed primarily randomized controlled trials from 2010 to 2013 of adults managing type 2 diabetes without insulin. All studies are evaluated in terms of the rigor of their design and their impact on glycosylated hemoglobin. The most efficacious interventions appear to be low-carbohydrate/glycemic load diets, combined aerobic and resistance training, and self-monitoring of blood glucose, which educates patients about the impact of their food selections and physical activity on their blood glucose.

Blood glucose pattern management in diabetes: creating order from disorder

BACKGROUND

Self-monitoring of blood glucose (SMBG) is the most accessible way to assess glycemic patterns, and interpretation of these patterns can provide reasons for poor glycemic control and suggest management strategies. Furthermore, diabetes management based on blood glucose (BG) patterns is associated with improved patient outcomes. The aim of this review is therefore to evaluate the impact of pattern management in clinical practice.

METHODS

We included a review of available literature, a discussion of obstacles to implementation of SMBG and pattern management, and suggestions on how clinicians and patients might work together to optimize this management feature.

RESULTS

The literature review revealed eight publications specifically describing structured approaches to SMBG and pattern management. Specific information on how SMBG might be structured to detect BG patterns, however, remains limited. Barriers to pattern management include not just practical reasons, but emotional and psychological reasons as well.

CONCLUSIONS

Patterns are not always easy to detect or interpret, but on-meter and web-based tools can support both patients and clinicians. Ultimately, successful pattern management requires education and mutual commitment from the clinician and patient--ongoing collaboration is needed to obtain, review, and interpret SMBG values and to make changes based on the patterns.

Blood‐Glucose Biosensors, Development and Challenges

Diabetes mellitus is one of the major causes of premature illness and death worldwide. The World Health Organization estimated that by 2030, 439 million people, corresponding to 7.8% of the world adult population, will live with diabetes. With an increasing diabetic population, a Blood Glucose Monitoring System (BGMS) is becoming an ever important tool for diabetes management. The history of blood biosensor development can be traced back to 1932, when Warburg and Christian reported the “yellow enzyme” from yeast changed to colorless upon oxidizing its substrate and resumed the yellow color after its oxidation by oxygen. Since then a lot of research and development has taken place on blood glucose sensors, and the biosensor technology has gone through three generations, with the current commercially available BGMS predominantly relies on the second generation of technology. The advantages and challenges of each generation are discussed. This chapter will examine in detail topics covering the areas of electrode substrate and electrode material selection, fluid detection electrode, reaction chamber, chemistry (electrolyte, polymer, enzyme and mediator), detection method, analytical performance, regulatory requirements and the manufacturing process. The chapter will close with the clinical utility and future direction and application of glucose biosensor include a brief introduction to the Continuous Blood Glucose Monitoring System (CGMS).

ProAct study: new features of insulin pumps improve diabetes management and glycemic control in patients after transition of continuous subcutaneous insulin infusion systems

BACKGROUND

Continuous subcutaneous insulin infusion (CSII) patients experience switches of pump systems on a regular basis. We investigated the impact of transition from older pumps to the Accu-Chek(®) Combo system (Roche Diagnostics Deutschland GmbH, Mannheim, Germany) on a patient's glycemic control and diabetes management.

PATIENTS AND METHODS

In total, 299 patients (172 female, 127 male; mean±SD age, 39.4±15.2 years; CSII duration, 7.0±5.2 years) were enrolled by 61 European sites into this uncontrolled prospective trial. Glycemic control, safety, and diabetes management parameters were measured at baseline and after 3 and 6 months. Changes from baseline were analyzed.

RESULTS

After transition to the new insulin pump, mean±SD hemoglobin A1c (HbA1c) values decreased from 7.8±1.1% (baseline) to 7.7±1.1% (end point). The proportion of patients with HbA1c <7.0% was slightly higher at the end of the study (29.6%) than at baseline (25.2%), whereas the proportion of patients with HbA1c >8.0% decreased (baseline, 36.2%; end point, 32.7%; P<0.05). The number of hypoglycemic episodes (blood glucose<70 mg/dL) improved slightly during the study (baseline, 40.4±34.0 events/quarter; end point, 39.2±33.9 events/quarter). Glycemic control improved significantly in the group with an initial HbA1c >8.0% (-0.46%; P<0.001) and remained solidly stable in the group with an initial HbA1c <7% (+0.04%; not significant). Short-term (<3 years) pump users (n=48) had a larger HbA1c decrease (-0.40%) than long-term (≥3 years) users (n=251) (-0.07%; P<0.05). The number of blood glucose measurements increased (3.7±1.9/day vs. 4.4±1.8/day; P<0.05), whereas the number of insulin boluses decreased (5.1±1.9/day vs. 4.6±1.5/day; P<0.05) during the study.

CONCLUSIONS

Transition from older pump systems to the Accu-Chek Combo system in a large patient population resulted in stable glycemic control with significant improvements in HbA1c in patients with unsatisfactory baseline HbA1c and shorter pump use. Increased frequency of self-monitoring of blood glucose and decrease of bolus frequency could suggest a more confident diabetes management and a reduced need for correction boluses.

Value and utility of self-monitoring of blood glucose in non-insulin-treated patients with type 2 diabetes mellitus

Self-monitoring of blood glucose (SMBG) levels provides important information regarding glycemic control for patients with diabetes, and is recommended by European and American diabetes organizations as an essential adjunct to periodic glycated hemoglobin (HbA1c) level monitoring. The benefits of SMBG in improving glycemic control in patients with type 1 diabetes and those with type 2 diabetes (T2DM) who are being treated with insulin are well recognized. In contrast, the potential role of SMBG in patients with T2DM not treated with insulin remains controversial, which may lead to underutilization of SMBG in this population. Structured SMBG, introduced as part of a treatment intervention, has been associated with modest but significant improvements in HbA1c levels in patients with T2DM who are not taking insulin as part of their management plan. Patient-obtained readings provide valuable real-time feedback on glucose responses to meals and exercise, and provide the patient with guidance on the day-to-day management of their diabetes. Studies have shown that when patients perform self-monitoring as part of their treatment interventions, support through appropriate educational initiatives is critical to ensure that patients understand the rationale for SMBG. Patients should be trained in correct testing technique and data recording for SMBG, as well as target blood glucose and goal HbA1c levels so that they will know when their SMBG readings are out of range. Technology has a potential role in facilitating SMBG-based interventions by improving patient-physician communication and optimizing glycemic control through the use of remote data uploading, data analysis tools, and, perhaps, even text messaging. This review outlines the benefits of SMBG in the management of patients with T2DM not treated with insulin, and highlights strategies for improving the effectiveness of SMBG-based treatment interventions in this population.

Changes in A1C levels are significantly associated with changes in levels of the cardiovascular risk biomarker hs-CRP: results from the SteP study

OBJECTIVE

The effect of therapeutic strategies on cardiovascular (CV) disease can be evaluated by monitoring changes in CV risk biomarkers. This study investigated the effect of a structured self-monitoring of blood glucose (SMBG) protocol and the resulting improvements in glycemic control on changes in high-sensitivity C-reactive protein (hs-CRP) in insulin-naïve patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

The Structured Testing Program (STeP) study was a prospective, cluster-randomized, multicenter trial in which 483 poorly controlled, insulin-naïve patients with type 2 diabetes were randomized to active control (ACG) or structured testing (STG) that included quarterly structured SMBG. Changes in A1C, hs-CRP, and glycemic variability (STG subjects only) were measured at baseline and quarterly.

RESULTS

Reductions in geometric mean hs-CRP values were significantly greater in the STG group at months 3 (P = 0.005), 6 (P = 0.0003), and 12 (P = 0.04) than in the ACG group. STG patients at high CV risk (>3 mg/L) showed significantly greater reductions in hs-CRP levels than ACG patients at high CV risk: -3.64 mg/dL (95% CI -4.21 to -3.06) versus -2.18 mg/dL (-2.93 to -1.43), respectively (P = 0.002). There was a strong correlation between reductions in hs-CRP and A1C in both groups: standardized coefficient (β) was 0.25 for the entire cohort (P < 0.0001), 0.31 for STG (P < 0.0001), and 0.16 for ACG (P = 0.02).

CONCLUSIONS

Reductions in hs-CRP level are associated with reductions in A1C but not reductions in lipids or glycemic variability. Comprehensive structured SMBG-based interventions that lower A1C may translate into improvements in CV risk, as evidenced by levels of the biomarker hs-CRP.

2-Year follow-up to STeP trial shows sustainability of structured self-monitoring of blood glucose utilization: results from the STeP practice logistics and usability survey (STeP PLUS)

We report findings from a follow-up survey of clinicians from the STeP study that assessed their attitudes toward and current use of the Accu-Chek(®) 360° View tool (Roche Diagnostics, Indianapolis, IN) approximately 2 years after the study was completed. The Accu-Chek 360° View tool enables patients to record/plot a seven-point self-monitoring of blood glucose (SMBG) profile (fasting, preprandial/2-h postprandial at each of the three meals, and bedtime) on 3 consecutive days, document meal sizes and energy levels, and comment on their SMBG experiences. Our findings showed that the majority of these physicians continue to use the tool with their patients, citing enhanced patient understanding and engagement, better discussions with patients regarding the impact of lifestyle behaviors, improved clinical outcomes, and better practice efficiencies as significant benefits of the tool.

Self-monitoring of blood glucose: guideline application rather than utilization restrictions on testing strips has potential to reduce diabetes healthcare costs in Italy

BACKGROUND

Self-monitoring of blood glucose (SMBG) is a proven tool to improve glycemic control, even if it might increase direct costs for diabetes management. In Italy, the purchase, prescription rules and responsibilities, and distribution of testing strips per type of patient are managed differently in each of the 20 Italian regions. The Italian scientific societies for diabetes (Società Italiana Diabetologia [SID] and Associazione Medici Diabetologi [AMD]) have issued validated guidelines for SMBG, but not all regions apply them. We investigated whether following SID-AMD guidelines would help decreasing SMBG and diabetes healthcare costs in Italy.

MATERIALS AND METHODS

We compared the regions applying and not applying SMBG guidelines for the mean number of testing strips used, number of hospitalizations (with the principal diagnosis of diabetes, excluding diabetes complications), and duration of hospitalization, as indirect measures of SMBG cost.

RESULTS

Regions applying the guidelines recorded higher SMBG testing strip utilization than regions not applying guidelines, but they recorded fewer hospitalizations for diabetes (36.2 ± 11.3 vs. 79.9 ± 27.8 hospitalizations per 100,000 inhabitants, P<0.002) and fewer days in the hospital (363 ± 106 vs. 685 ± 194 days of hospitalization for diabetes per 100,000 inhabitants, P<0.002).

CONCLUSIONS

Our data suggest that application of guidelines for SMBG prescription and a strict cooperation between health providers and regional health economic deciders were associated with greater utilization of SMBG testing strips. They were also associated with significantly reduced number of hospitalizations and reduced overall duration of hospitalization for patients with diabetes, potentially saving healthcare costs.

Results that matter: structured vs. unstructured self-monitoring of blood glucose in type 2 diabetes

Self-monitoring of blood glucose (SMBG) is one component of diabetes management. SMBG presents information about current glycemic status and provides the ability to obtain immediate feedback regarding the impact of behavioral and pharmacological interventions on glucose levels. However, SMBG is useful only when the glucose information is understood correctly, data are accurately interpreted, and results prompt appropriate therapeutic actions. The International Diabetes Federation (IDF) recently published guidelines for SMBG use in non-insulin treated people with diabetes, recommending that SMBG should be used only when patients and/or their clinicians possess the ability and willingness to incorporate SMBG monitoring and therapy adjustment into their diabetes care plan. If SMBG is used, the IDF also recommends that structured SMBG be performed utilizing defined regimens to meet individual needs. Structured SMBG can be performed as daily glucose profiles that are representative of daily glucose excursions. Measuring preprandial/postprandial blood glucose (bG) levels on consecutive or alternating days ("testing in pairs") also provides impactful glucose information for daily diabetes management. This article reviews recent studies that appropriately utilized structured SMBG as an integral component of comprehensive diabetes management and discusses how their findings support the IDF recommendations. Our goal is to help clinicians make more informed decisions about the value and utility of SMBG in diabetes management.