Tayside Diabetes MCN Handbook
Guidelines for self monitoring of blood or urine glucose in diabetes

Type 1 diabetes

 

It is recommended that all people with Type 1 diabetes undertake self monitoring of blood glucose (SMBG). The use and frequency of testing, and target blood glucose level should be agreed between the person with Type 1 diabetes and their health care team.

 

Type 2 diabetes

 

Evidence supporting patient benefit from self monitoring of blood glucose (SMBG) in Type 2 diabetes is poor, with two recent randomised controlled trials showing no improvement in HbA1c in patients with non-insulin treated Type 2 diabetes who were newly diagnosed (ESMON et al. BMJ 2008) or stably treated (DiGEM Farmer et al. BMJ 2007). The ESMON study also showed SMBG increased depression scores. The data for self monitoring of urinary glucose is poor, but there is no evidence that urine testing is better than no intervention.  Based on a review of evidence SIGN Guideline 116 on the Management of Diabetes (2010) stated that routine self monitoring of blood glucose in people with Type 2 diabetes who are using oral glucose-lowering drugs (with the exception of sulphonylureas) is not recommended.

 

Recommendation

 

Long term use of SMBG

  • People with Type 2 diabetes treated with insulin who should be using SMBG to guide their insulin doses, and manage symptoms of hypoglycaemia.
  • People with Type 2 diabetes treated with sulphonylureas who drive and wish to monitor blood glucose before or during driving.

 

Short term use of SMBG

 

The need for SMBG should be reviewed after the indication for its use has resolved, or at 6 monthly intervals. In particular, attention should be paid to whether someone is utilising the results of glucose monitoring appropriately.

  • At diagnosis if there is diagnostic uncertainty around diabetes type or rate of progression.
  • People with Type 2 diabetes treated with sulphonylureas who have had symptoms of hypoglycaemia or are at risk of hypoglycaemia.
  • People with Type 2 diabetes commencing glucocorticoid treatment.
  • People who have had pancreatic surgery and/or pancreatitis.
  • At times during intercurrent illness e.g. following surgery, acute illness.
  • People with Type 2 diabetes in pregnancy or gestational diabetes.
  • Where someone wishes to gain insight into their diabetes, and how blood glucose varies with dietary modification and exercise.

 

Use of SMBG not recommended

 

People with Type 2 diabetes who are diet or tablet controlled (except as above).

 

Use of self monitoring of urine glucose

 

This is not recommended for routine clinical practice

 

Monitoring Management

 

Health care professionals issuing blood glucose meters should:

  • Provide clear guidance regarding use of the meter including advice on interpretation of the blood glucose results
  • Provide contact details for the healthcare professional responsible for providing advice regarding diabetes management
  • Assess and agree target blood glucose range, frequency of testing and duration of monitor use taking account of individual need

Meter companies provide monitoring diaries, technical support, and notification of safety hazards relative to their product

 

Blood Glucose Meter for use by NHS Tayside Staff

 

NHS Tayside has converted to the AccuChek Inform II blood glucose meter for use in hospital settings.  All staff who routinely use a glucose meter for patient care at Ninewells (excepting TORT), Carseview, Perth Royal Infirmary, Murray Royal, Royal Dundee Liff, Royal Victoria, Arbroath Infirmary, Ashludie, Whitehills, Little Cairnie, Stracathro, Montrose Infirmary, Links, Sunnyside, Brechin Infirmary, Blairgowrie Hospital, St Margaret's Hospital, Aberfeldy Hospital, Pitlochrry Hospital, Crieff Hospital.  Staff must undergo training andwill be issued with personalised barcodes in order to use the new meters.  

 

Blood Glucose Meters for use by Patients

 

A balance needs to be maintained which limits the number of different meters recommended or issued to patients but still allows for provision of a meter that is suitable for individual patient need in relation to user acceptability and ease of use.  The Formulary was agreed as a result of a review of meters by healthcare professionals and patients taking into account functionality, patient support, staff support, quality assurance and cost.

 

Below are the recommended meters for use:

 

Core Meter: For all people with diabetes

  • TRUEyou and TRUEyou mini - Nipro Diagnostics Helpline Tel 0800 0858808

 

Specialist Meters – For use recommended by the Specialist Diabetes Team:

  • Contour Link - Links with an insulin pump, Bayer Helpline Tel 0845 6006030.
  • Freestyle Insulix - Abbott Helpline Tel 0500 467466
  • Accucheck Expert - Roche Helpline Tel 0800 701000
  • iBG Star - Sanofi Helpline Tel: 08000 352525
  • Glucomen LX - For people with Type 1 diabetes this meter tests for blood glucose and ketones.  Menarini Helpline Tel 0800 243667

 

Next review September 2015