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CONTINUING PROFESSIONAL DEVELOPMENT
People with diabetes need to take an active role in managing their
Although the clinical value of self-monitoring of blood glucose
(SMBG) in insulin naïve patients is heavily debated1
, when completed in
a structured way, SMBG enhances self care. It enables patients to assess
the effects of lifestyle changes and medicines on glycaemic control,
and empowers them to participate in and take responsibility for their
Patients who improve their knowledge,
skills and confidence to manage their
diabetes have better health outcomes.
Pharmacists are well placed to educate
people with diabetes and encourage
appropriate self care, including
promoting effective SMBG practices in
those with type 2 diabetes.
Type 2 diabetes in Australia
Type 2 diabetes is a significant and
growing health concern in Australia.
Nearly one million Australians reported
having diabetes in 2012 and of these
approximately 85% had type 2 diabetes.
The prevalence of type 2 diabetes has
increased considerably from 1.1% in
1995 to 3.3% in 2007–08.
associated with significant morbidity
due to macro and microvascular
complications such as cardiovascular
disease, stroke, retinopathy,
nephropathy and neuropathy, as well as
reduced life expectancy and quality of
Not surprisingly, the burden of type
2 diabetes is considerable; the annual
cost including healthcare costs,
carer costs and productivity losses is
estimated to be more than $10 billion.2
Good glycaemic control is the
cornerstone of diabetes management.
However, evidence suggests that less
than half of people diagnosed with type
2 diabetes achieve the recommended
targets for glycosylated haemoglobin.
Structured SMBG has been associated
with improved glycaemic control in
type 2 diabetes;3,9-11
importance of structured blood glucose
monitoring, and educating people with
type 2 diabetes to understand their
blood glucose results, may lead to better
SMBG in type 2 diabetes
SMBG is widely recognised as a core
component of diabetes self care.3,9
For patients with insulin-treated
type 2 diabetes, SMBG is used to
monitor the day-to-day adjustment
of insulin doses to reduce glycaemic
in type 2
BY ANNA EZZY MPS
Anna Ezzy the Resource Development Manager
based in the PSA Melbourne office.
After reading this article, pharmacists should be
• Discuss the role of self-monitoring of blood
glucose (SMBG) in type 2 diabetes management
• Explain how structured SMBG relates to
the International Diabetes Federation
recommendations for SMBG in type 2 diabetes
• Understand the basic steps of diabetes pattern
• Identify activities and services pharmacy can
implement to promote effective SMBG.
Competency standards (2010) addressed: 1.3,
Accreditation number: CAP140606B
evidence from clinical studies, SMBG
is also recommended as a way
to improve glycaemic control for
insulin-naïve patients with type 2
diabetes. The rationale is that feedback
on blood glucose levels improves
understanding of the impact of diet,
exercise and medicines on glycaemic
control, and improves self-efficacy and
motivation to adhere to treatment.
SMBG can also be used to support
healthcare professionals to provide
individually tailored advice to patients
about lifestyle modifications, accelerate
titration of diabetes medicines, and
optimise diabetes management.
The International Diabetes Federation
(IDF) has established recommendations
for SMBG in type 2 diabetes (see Box 1).
and diabetes pattern
In their guidelines for SMBG in type 2
diabetes, the IDF emphasise that SMBG
is an effective self-management tool,
but only when results are reviewed
and acted upon by patients and/or
healthcare providers to actively modify
behaviours or adjust treatment.3,14
However, studies indicate that there
is often a lack of education on how to
interpret blood glucose readings, and
patients and healthcare professionals
may not act on results.
Structured SMBG describes an approach
to blood glucose monitoring where
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