Self-monitoring of blood glucose and type 2 diabetes mellitus

Self-monitoring of blood glucose (SMBG) in management of type 2 diabetes mellitus continues to be debated. However, SMBG is recognized as being useful (professional agreement) in three situations: sensitizing the type 2 diabetic patient to the advantages of diet control and physical exercise, determining and adapting the dosage of oral antidiabetic medication at the beginning of treatment or during a dosage change, and monitoring plasma glucose during intercurrent disease or during a treatment that may lead to acute blood glucose imbalance. However, the frequency, the timing of blood glucose monitoring, and the target blood glucose values remain poorly defined. It is well known that the postprandial period covers approximately 50% of the day, and several recent studies have shown the respective role of fasting, pre- and postprandial glucose levels in overall diurnal hyperglycemia in the type 2 diabetic and their respective contribution to the mean HbA1c level depending on how well blood glucose levels are controlled. Based on these studies, it is now possible to propose a SMBG scheme, specific to a given patient and for a defined therapeutic objective, taking the three physiological periods into account: postprandial, postabsorptive, and fasting. However, the optimal use of SMBG requires patient education and training. Using a specific, adapted, and optimal SMBG is only advantageous if the results are usable, and used, by the patient and healthcare professionals to improve the quality of blood glucose control (as shown by the HbAlc level) and the safety of intensified oral antidiabetic treatments (minimal risk of hypoglycemia).