Self monitoring blood glucose and quality of care

Studies like the DCCT and the UKPDS showed that prevention of Type 1 diabetes mellitus complications can be obtained if glucose level is maintained as close as possible to normal. Consequently management of diabetes has significantly changed in the last two decades since the aim of maintaining a good metabolic control has been pursued through intensive insulin therapy and self-monitoring blood glucose (SMBG). However, although SMBG is extremely helpful in preventing and treating hypoglycaemia and ketoacidosis, its role in maintaining a good metabolic control is controversial. Both the American Diabetes Association and the International Society for Paediatric and Adolescent Diabetes recommend the use of SMBG to maintain specific glycaemic levels but suggest that this is possible only if the patient achieves good skills in interpreting self-monitored data and consequently in self-adjusting insulin therapy and modifying eating and activity. Few studies have addressed this question and almost no data is available on SMBG and metabolic control in children with T1DM. However it can be stated that SMBG, although considered a cornerstone in diabetes care, is a necessary but not sufficient tool for the patient to achieve self-management and that only self-management leads to a good metabolic control. Paediatric diabetologists have a crucial role in providing long-term, continuative education in the use of SMBG and in self-management of diabetes.