Glycemic Targets Part 1: SMBG & CGM

One of the most critical responsibilities of patients with diabetes is patient self-monitoring of blood glucose (SMBG). In order to assess glycemic levels, SMBG is available to caregivers and patients to evaluate the safety of the suggested glycemic management plan. It is not only important to check blood glucose levels, but continuous glucose monitoring (CGM) is essential to create a treatment plan for type 1 and type 2 diabetes.

Per the Standards of Medical Care in Diabetes, recommendations are as follows:

• Patients using intensive insulin regimens should perform SMBG prior to meals, snacks, at bedtime, prior to exercise, when they think their glucose level is low, after treating their low blood sugar until they are regular, and before they perform a task such as driving.
• SMBG may help to guide treatment decisions and/or self-management for patients taking less frequent insulin injections or noninsulin therapies.
• When SMBG is prescribed, patients should receive ongoing instruction and regular evaluation of SMBG technique, SMBG results, and the patient’s ability to use SMBG data to adjust therapy.
• When used correctly, CGM combined with intensive insulin regimens can lower A1C in adults 25 years of age or older with type 1 diabetes.
• In patients with frequent hypoglycemic events, CGM is a useful tool for preventing future hypoglycemic episodes.

Patient self-monitoring of blood glucose levels is useful for guiding medical nutritional therapy, physical activity, preventing hypoglycemia, and adjusting medications. The needs and goals, as well as the SMBG frequency, depends on the specific patient, and the accuracy of SMBG relies on not only the instrument, but the user as well.

In part 2 of our blog, we will explain the A1C test, goals and recommendations, and limitations of A1C testing.