Self-monitoring of blood glucose (SMBG) has been challenged in terms of its cost effectiveness for people with type 2 diabetes who do not use insulin.
By Shelley Diamond BScPhm
Despite these challenges, the Canadian Diabetes Association continues to recommend its use for a variety of reasons. These include reduced episodes of hypoglycemia as well as a reduction in diabetes complications.
The recommendations for people with type 1 diabetes or those with type 2 diabetes on insulin are clearly defined. This is not the case for those with type 2 not using insulin. Currently, the number of SMBG tests is reported to be less than one per day for people with type 2 diabetes not using insulin.
The current recommendations from the most recent Canadian Diabetes Association Clinical Practice Guidelines recommend that people with type 2 diabetes who are managing their condition with lifestyle and/or oral medications should individualize their blood glucose monitoring in consultation with their diabetes healthcare practitioner. As pharmacists, these are the majority of patients we encounter on a daily basis.
Helping patients with type 2 diabetes
So how do you help provide practical information to your patients with type 2 diabetes, who may be trying to follow a healthy eating plan and are maintained on potentially one or two oral medications, to incorporate more physical activity into their day?
It is easy for many people to assume that everything will be fine if they just follow this plan to the best of their ability. The rationale for not having specific recommendations for the frequency of blood glucose testing is based on the fact that many people do not know how to act on the numbers and therefore this is simply a waste of healthcare resources.
There are a couple of easy ways for you to help your patients right away. The first opportunity is to ensure that a log book is available for patients to gain a better understanding of their blood glucose levels based on their daily eating and activities. Although blood glucose meter technology these days allows for larger memories for storing readings, or even the ability to flag a reading as either a pre-meal or post-meal level, there are still benefits to using a paper-based record. A log book provides the ability to view blood glucose results in columns to identify patterns that result in levels outside of the target range. In addition, there is the opportunity to add comments right next to the levels, which also help with interpretation of the results.
In addition, your patients will benefit from experimenting with different testing times in order to gain an appreciation of the impact that certain food choices, activities or medications may have on their levels.
In terms of gaining an understanding of how their selection of food affects their blood glucose levels, ask your patients to test before and after a different meal a few times during the week. This will help them to understand if the choice and amount of food they select for breakfast, lunch or dinner is appropriate to maintain their levels.
Also have them test repeatedly before, during and after exercise so they can see the impact of their activity on their blood glucose. And lastly, if their diabetes healthcare provider has recommended a change in their medication, it is valuable to ensure there has been an impact based on this change.
Recommending patients to test their blood glucose is only advantageous if you provide the necessary assistance to allow their effective use of the SMBG data. You can play an important role in helping patients review their results so they can make the appropriate choices in their daily living. There is no argument that SMBG is beneficial for any person with diabetes when healthcare professionals work closely and collaboratively with their patients.
Shelley Diamond BScPhm is the president of Pedipharm Consultants and Diabetes Care Community Inc. (www.diabetescarecommunity.ca)