Use and abuse of glucose reflectance meters

All diabetic patients who had been using home glucose monitoring devices during the last 2 yr in the area served by the specialist Diabetes Unit in Christchurch, New Zealand were invited to complete a questionnaire designed to provide information on glycemic control, treatment regimen, and patterns of glucose recording. Questionnaires were completed by 111 of 152 patients, of whom 99% were using insulin. The period of use of reflectance meters was between 1 and 18 mo. Forty-three percent used their meters in a manner considered unsatisfactory and 15% failed to write down results. Those patients recording for the longest periods showed a significant trend to more inefficient use of devices. Forty-four percent still relied on their medical supervisor for treatment changes, but most attended infrequently (mode 12 wk; range 1-52 wk). Most frequently, treatment changes were to insulin dose and only one-third had adopted more "physiologic" regimens incorporating rapid-acting insulin. Blood glucose control was not significantly changed from that found in a group of diabetic subjects during the first weeks of monitoring. These results suggest that (1) many patients do not use home glucose monitoring devices in a manner likely to allow rational modification to therapy, (2) neither patients nor family physicians have reacted appropriately to high recorded values, and (3) chronic use of home monitoring has not resulted in good glycemic control for many patients.