Real-world use of self-monitoring of blood glucose in people with type 2 diabetes: an urgent need for improvement

Acta Diabetol. 2018 Oct;55(10):1059-1066. doi: 10.1007/s00592-018-1186-z. Epub 2018 Jul 30.


Aims: To assess use of self-monitoring of blood glucose (SMBG) in type 2 diabetes (T2DM) in the context of a continuous quality improvement initiative (AMD Annals).

Methods: 14 quality-of-care indicators were developed, including frequency of SMBG, fasting blood glucose (FBG), and post-prandial glucose (PPG) levels, and hypoglycemia and hyperglycemia episodes. Clinical data and SMBG values downloaded from any glucose meter were obtained from electronic medical records. The most frequently used glucose-lowering treatment regimens were identified and the indicators were assessed separately by regimen.

Results: Overall, 21 Italian centers and 13,331 patients (accounting for 35,657 HbA1c tests and 8.44 million SMBG values collected during 2014 and 2015) were included in the analysis; 11 therapeutic regimens were selected. Patients in regimens not including insulin performed 15-23 measurements per patient-month, those treated with basal insulin 32.1 tests/patient-month, and those treated with basal and short-acting insulin 53-58 tests/patient-month. In all treatment regimens, PPG measurements represented a minority of all tests; pre-breakfast measurements accounted for about 50% of all FBG values. Mean FBG levels exceeded 130 mg/dl in 49.3-88.3% of the cases in the different treatment regimens, while PPG levels were over 140 mg/dl in 46.7-81.0%. From 5.7 to 32.7%, patients in the different regimens had at least one episode of hypoglycemia (< 70 mg/dl), while from 3.7 to 47.7% had at least one episode of hyperglycemia (> 300 mg/dl).

Conclusions: SMBG is underutilized in patients with T2DM treated or not with insulin. In all treatment groups, PPG is seldom investigated. Poor metabolic control and rates of hyper- and hypoglycemia deserve consideration in all treatment groups.

Keywords: Adherence; Benchmarking; Quality of care; Self-monitoring blood glucose; Type 2 diabetes.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / analysis*
  • Blood Glucose / metabolism
  • Blood Glucose Self-Monitoring / methods
  • Blood Glucose Self-Monitoring / standards
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Female
  • Glycated Hemoglobin / analysis
  • Glycated Hemoglobin / metabolism
  • Health Services Needs and Demand*
  • Humans
  • Hyperglycemia / drug therapy
  • Hyperglycemia / epidemiology
  • Hypoglycemia / blood
  • Hypoglycemia / chemically induced
  • Hypoglycemia / epidemiology
  • Insulin / therapeutic use
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data
  • Postprandial Period
  • Quality Improvement
  • Quality of Health Care* / standards
  • Retrospective Studies


  • Blood Glucose
  • Glycated Hemoglobin A
  • Insulin