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Using SMBG in the Insulin-Naïve

Using SMBG in the Insulin-Naïve

Achieving glycemic control is paramount to helping patients prevent the development of diabetes-related complications. According to William H. Polonsky, PhD, CDE, several tools are available to monitor the day-to-day trends in glycemia, one of the most important of which has been self-monitoring of blood glucose (SMBG). “SMBG has been considered a key component of patient management,” he says. “There remains widespread agreement that SMBG should be available to all patients with diabetes regardless of their current treatment strategy.” In Diabetes Care, Dr. Polonsky and colleagues had a study published showing that appropriate use of structured SMBG significantly improves glycemic control in insulin-naïve patients with type 2 diabetes (Table 1). The analysis also revealed that structured SMBG facilitated more timely and aggressive treatment changes without decreasing general well-being. Despite these findings, a number of other recent reports have challenged the notion that all patients should use SMBG because it may have little impact on glycemic control. Structure Matters Implementing SMBG in unstructured ways without training patients and clinicians is likely to be a waste of resources. However, the findings of recent studies that have challenged SMBG use do not mean that this monitoring strategy should be eliminated from clinical use. “Like any good tool, SMBG may be used well or poorly,” says Dr. Polonsky. “Unlike a medication, SMBG is not uniformly administered across all patients and settings.” SMBG varies considerably by the clinical question it addresses and the recommended frequency and timing of tests. The expertise of patients regarding its use and the involvement and knowledge of clinicians in interpreting and responding to SMBG data are other important factors. Dr....
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