Self-Monitoring of Blood Glucose in Type 2 Diabetes: Steps toward consensus

Those involved in type 2 diabetes care must be puzzled by the lack of consensus on self-monitoring of blood glucose (SMBG) (1,2,3), especially in non–insulin-treated patients. This is reflected by wide between-country variation in reimbursement for glucose meters and strips. Balanced evaluation of available data is required; however, further trials are needed to provide robust evidence as to how and in which groups SMBG use is justified. Accordingly, diabetologists and epidemiologists involved in recent SMBG studies in type 2 diabetes met during the 2006 International Diabetes Federation Congress and established an International SMBG Working Group for the exchange of data, analyses, and ideas. Although there was no systematic invitation strategy, 34 individuals from 13 countries have confirmed interest.

A cross-sectional Working Group survey generated data from Argentina, Australia, Canada, China, Germany, India, Italy, Netherlands, Norway, Pakistan, Tanzania, the U.K, and the U.S. There are no published data from one-half of these countries, and none have national-level data. For insulin-treated type 2 diabetic patients, SMBG prevalence is highest in countries providing free strips and is lowest in countries like India where cost is a major barrier. For patients taking oral antidiabetes drugs, only Norway and the U.K. provide free strips; however, in one-half of the countries surveyed, most of these patients use SMBG. The between-country difference in frequency of strip use is also marked.

Our data suggest that factors influencing SMBG in type 2 diabetes include country of residence, diabetes treatment, and cost. The paucity of national-level data are surprising given the high cost. National guidelines unanimously recommend SMBG in insulin-treated type 2 diabetes (1); however, there is lack of consensus on the value of SMBG in non–insulin-treated patients. This ad hoc survey has understandable gaps, and we would like to invite others to contribute and participate in future International SMBG Working Group activities.