Structured monitoring: The right tools for the job

Structured monitoring - or self-monitoring of blood glucose (SMBG) with a plan and a purpose - can take different forms and can be extremely useful in influencing patient behaviour. It not only gives your patients periodic updates on their blood glucose levels, but also provides data that can inform conversations to maximise therapy outcomes.

National and international diabetes organisations view structured SMBG as a valuable supplementary tool for recording the acute and intra-day details behind three-month HbA1c measurements. However, healthcare professional-to-patient communication and a clear understanding of the goal and therapeutic element being addressed is a vital component of success.

According to the International Diabetes Federation’s Guideline for Self-Monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes, communication and intent are key to structured monitoring¹:

SMBG should be used when patients and healthcare professionals have the knowledge, skills and willingness to incorporate SMBG monitoring and therapy adjustment
SMBG protocols (intensity and frequency) should be individualised to address each patient’s educational, behavioural and clinical needs.

Why use structured monitoring?

SMBG examples	Purpose	Action
Focused monitoring—intensive monitoring for a limited duration to address a specific issue
Pattern testing	Issue identification Education or awareness Engagement; unbiased motivator for diabetes self-management	Therapy adjustment Behaviour change
Paired testing	Education or awareness Engagement; self-management Bolus calculation Bolus type/frequency in pump therapy	Therapy adjustment Behaviour change
Titration testing	Insulin regime: total daily dose (TDD), bolus/basal doses Bolus type/frequency in pump therapy	Therapy adjustment
Individualised monitoring over longer periods of time
Insulin management testing	Insulin regime: TDD, bolus/basal doses	Adjust dosage, timing, or insulin type
Lifestyle intervention testing	Glycaemic control in non-insulin requiring people with diabetes	Behaviour change: activity, stress, schedule, diet, snacking, alcohol

Structured monitoring examples

Monitoring regime	Description	Application
Staggered profile	Pre- and postprandial BG measurements for one meal per day or overnight	Staggering mealtimes provides more data and a clearer picture of glucose levels and patterns
7-point profile	Pre- and postprandial BG measurements for three meals per day and bedtime BG for a short time period, such as three consecutive days	For an overall assessment of the glucose profile, such as before a clinical visit
Paired testing	Pre- and postprandial BG measurements for the same meal (breakfast, lunch, or dinner) on seven consecutive days	Specific mealtime data for evaluation of postprandial glucose excursions; can support identification of the need for additional medications or therapy changes to target postprandial hyperglycaemia

Accu-Chek® Testing in Pairs

A pre- and post-event monitoring plan to explore the cause and effect of blood glucose fluctuations related to events such as foods, lifestyle and current medication. Use this tool to help patients become active participants in their diabetes management with “before and after” monitoring:

Show the relationship between blood glucose and meals, exercise or medication
Make the connection between healthy behaviours and improved glycaemic control
Provide affirmation for healthy choices

Meaningful Blood Glucose Monitoring video series

The meaningful blood glucose monitoring series of short educational videos provides guidance for self-monitoring for patients with type 2 diabetes. These videos support patients by guiding them through:

How to accurately check their blood glucose levels
When, how often and why blood glucose levels should be monitored
What to do with the readings
How patients can motivate themselves to self-monitor

You can feel confident recommending these user-friendly Accu-Chek tools to your patients. These tools help your patients see the effects of their actions while providing data that can be used to inform treatment, all in an easily understood format. Further patient resources can be found here.

References

International Diabetes Federation Clinical Guidelines Task Force, SMBG International Working Group. Guideline on Self-Monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes. 2009. https://www.idf.org/e-library/guidelines/85-self-monitoring-of-blood-gl….
Fisher L et al. The impact of structured blood glucose testing on attitudes toward self-management among poorly controlled, insulin-naïve patients with type 2 diabetes. Diabetes Res Clin Pract. 2012 May;96(2):149-55.
Polonsky WH, et al. A structured self-monitoring of blood glucose approach in type 2 diabetes encourages more frequent, intensive, and effective physician interventions: results from the STeP study. Diabetes Technol Ther. 2011 Aug;13(8):797-802. doi: 10.1089/dia.2011.0073.

Additional sources:

Di Molfetta S, Bosi E, Ceriello A, Cucinotta D, Tiengo A, Scavini M, Piccolo C, Bonizzoni E, Acmet E, Giorgino F; PRISMA STUDY GROUP. Structured self-monitoring of blood glucose is associated with more appropriate therapeutic interventions than unstructured self-monitoring: a novel analysis of data from PRISMA. Diabetes Res Clin Pract. 2021 Sep 27;109070. doi: 10.1016/j.diabres.2021.109070

Russo GT, Scavini M, Acmet E, Bonizzoni E, Bosi E, Giorgino F, Tiengo A, Cucinotta D. The Burden of Structured Self-Monitoring of Blood Glucose on Diabetes-Specific Quality of Life and Locus of Control in Patients with Noninsulin-Treated Type 2 Diabetes: The PRISMA Study. Diabetes Technol Ther. 2016 Jul;18(7):421-8. doi:10.1089/dia.2015.0358. Epub 2016 Jun 21.

Scavini M, Bosi E, Ceriello A, Giorgino F, Porta M, Tiengo A, Vespasiani G, Bottalico D, Marino R, Parkin C, Bonizzoni E, Cucinotta D. Prospective, randomized trial on intensive SMBG management added value in non-insulin-treated T2DM patients (PRISMA): a study to determine the effect of a structured SMBG intervention. Acta Diabetol. 2013 Oct;50(5):663-72. doi: 10.1007/s00592-011-0357-y.