Ministry of Health
Self-Monitoring of Blood Glucose (SMBG)
Important information about your patients with type 2 diabetes who are not using insulin:
Evidence shows that most of these patients do not have to test as much as they do now, and this will not affect their health in a negative way. Learn more about the evidence.
Encourage these patients to Test With Purpose. In other words, encourage these patients to test their blood glucose levels only when they have a reason to test. Make sure they know how to interpret the results, and what action to take. Learn more about when these patients may benefit from self-monitoring of blood glucose (SMBG).
When people think of managing diabetes, they often think of drug therapy and self-monitoring of blood glucose (SMBG).
Management of diabetes also includes much more than blood glucose testing. You know this, and your patients likely know this too – but you may need to remind them regularly about how important it is to:
- eat a healthy, nutritious diet
- exercise regularly
- maintain a healthy weight
- take all prescribed medications as directed
- monitor blood pressure
- manage cholesterol
- ensure good foot care
- see you regularly and talk to you about their A1C results
Some Answers to Frequently Asked Questions:
- If your patient needs to test, which meter should they use?
- What are the benefits of the "Test With Purpose" approach for patients with type 2 diabetes who are not using insulin?
- Is the “Test With Purpose” approach suitable for other patients with diabetes: pregnant women, kids and others with type 1 diabetes, and people with type 2 diabetes who are using insulin?
- Access tools and resources to help you and your patients manage their diabetes.
Learn more about the Evidence
For patients with type 2 diabetes who are not using insulin, evidence shows that routine self monitoring of blood glucose (SMBG) does not lead to a clinically significant improvement in glycemic control.
A systematic review and pooled analysis of all available randomized controlled trials was conducted by the Canadian Agency for Drugs and Technologies in Health (CADTH). This review showed that routine SMBG among patients with non–insulin-treated type 2 diabetes was associated with a statistically significant, but not clinically relevant, improvement in glycemic control (difference in A1C = -0.25%, 95% CI -0.36%, -0.15%).
For patients who were not using pharmacotherapy to control their diabetes, improvements in glycemic control were less pronounced and statistically non-significant.
In addition, the systematic review found little evidence to suggest that SMBG in non–insulin-treated type 2 diabetes provides any extra benefits in terms of quality of life and patient satisfaction. In fact, an association between SMBG and depression was found.
For more information, please visit the CADTH website to view SMBG self monitoring reports.
TopLearn more about when these patients may benefit from self-monitoring of blood glucose (SMBG).
If one of your patients with type 2 diabetes is not using insulin and their diabetes is well controlled then a regular A1C test may be all you need as a monitoring plan for this patient.
Depending on their circumstances, some of these patients may also want or need to test their blood glucose levels at home. For example, patients may benefit from SMBG when:
- they are taking medications that increase their risk of hypoglycemia
- they have a history of very low hypoglycemic episodes when they have unplanned physical activity
- they have a change in their regular eating patterns
- their diabetes is not controlled to the degree that you and your patient would like
- their diabetes medications have been recently changed
- they are sick
- they are pregnant or planning a pregnancy
What about newly-diagnosed patients?
Patients often use SMBG as a tool to learn about their diabetes and fine-tune their diet and exercise choices. Once a patient has an understanding of their diabetes and diabetes management, and their diabetes is well controlled, health professionals can help these patients by reviewing the use of SMBG as an on-going monitoring tool. Teach them about testing with purpose. Reassure them that it is okay to ease off on testing when they are doing well, and use regular A1C tests to monitor their blood glucose levels.
If your patient needs to test, which meter should they use?
There is no evidence that any one meter or strip is clinically more effective or more cost effective than any other at measuring blood glucose in a sample.
The choice of meter for a specific patient will depend on patient agility, patient preference (i.e. size of device, display features), meter availability, trainer familiarity with specific meters and cost of test strips.
CADTH reviewed the evidence on the clinical and cost effectiveness of alternative blood glucose monitors and test strips available in Canada. The CADTH report described one open-label study that found that using a meter with an integrated electronic logbook may reduce blood glucose (A1C) levels compared to using a paper logbook. No evidence on the most cost effective models was found. However, findings from this report should be interpreted with caution, given the lack of evidence overall and the limitations of the included studies.
A summary of available evidence is provided in a Rapid Response Report published in April 2011 by CADTH.
What are the benefits of the “Test With Purpose” approach for patients with type 2 diabetes who are not using insulin?
Adopting a “Test With Purpose” approach with these patients results in benefits for you, your patients and the health care system.
You can focus your valuable time on educating patients about important self-management principles, answering questions and helping patients resolve health issues as they arise, rather than focusing on SMBG test results that do not provide clinical benefit to patients.
Your patients will have less pain from testing, and less expense for lancets and related supplies. Your patients will also have less disruption to their daily lives if they do not have to focus on regular SMBG.
In 2010/2011 British Columbian’s spent $23.7 million on test strips for people with diabetes and not using insulin. If these patients “Test With Purpose,” the amount of money needed to pay for test strips that are no longer needed can potentially be redirected to cover other medications and supplies that provide more clinical benefit to patients.
Is the “Test With Purpose” approach suitable for other patients with diabetes: pregnant women, kids and others with type 1 diabetes, and people with type 2 diabetes who are using insulin?
The “Test With Purpose” approach described here only applies to people with type 2 diabetes who are not using insulin.
For other groups, the Canadian Agency for Drugs and Technologies in Health (CADTH) recommends:
- for women with gestational diabetes not using antidiabetic drugs, the daily frequency of SMBG should be individualized.
- for adults and children with type 1 diabetes, the daily frequency of SMBG should be individualized.
- for adults with type 2 diabetes using insulin, the daily frequency of SMBG should be individualized, with a maximum weekly frequency of 14 tests per week for most of these patients.
Tools and resources to help you and your patients manage their diabetes are provided here
(click on the thumbnail image for a printable version of the tool you would like).
- Self-Monitoring of Blood Glucose (SMBG) Alternate Prescription Pad – provides patients with a summary of recommendations for SMBG for patients with type 2 diabetes not using insulin including guidance on when to test and a comprehensive list of tips for managing diabetes.
- SMBG Quick Reference Prescribing Aid – a quick reference card containing CADTH’s key messages on prescribing SMBG in patients with diabetes and cost information about SMBG (in Canada and specifically in B.C.).
- CADTH SMBG Optimal Therapy Newsletter - a summary of key clinical messages on the prescribing and use of blood glucose test strips for self-monitoring of blood glucose, designed to support decision making by health care professionals.
- “Test with Purpose” Posters – print and display these posters in your office, waiting area or other locations to stimulate discussion with patients and reinforce the “Test With Purpose” message.
- BC Guidelines – Diabetes: B.C. specific clinical practice guidelines on diabetes. BC Guidelines are developed by the Guidelines and Protocols Advisory Committee (GPAC), a joint committee of the BCMA and the Ministry of Health. GPAC has engaged practicing physicians in B.C. - including general practitioners and specialists - to evaluate clinical evidence, and publish clinical practice guidelines on numerous conditions, with particular focus on circumstances in British Columbia.
- BC Guidelines – Diabetes Patient Care Flow Sheet: a tool for use in a patient's chart that is designed to help clinicians collect and organize individual patient data at each appointment, and detect trends in these data over time.
- Education for Quality Improvement in Patient Care (EQIP) : SMBG Provincial Portrait: Provincial portrait of blood glucose test strip use among patients with diabetes not on insulin therapy. For more information, please visit the EQIP website.