Karter Andrew J
Division of Research, Kaiser Permanente, Oakland, California, USA.
Endocr Pract. 2006 Jan-Feb;12 Suppl 1(0 1):110-7. doi: 10.4158/EP.12.S1.110.
To examine the role of self-monitoring of blood glucose (SMBG) in the management of diabetes mellitus.
Current trends and published evidence are reviewed.
Despite the widespread evidence that lowering glycemic levels reduces the risks of complications in patients with diabetes, little improvement in glycemic control has been noted among patients in the United States and Europe in recent years. Although SMBG has been widely used, considerable controversy surrounds its role in achieving glycemic control. The high cost of test strips has made considerations regarding appropriate recommendations for SMBG a priority, especially in light of the current climate of health-care cost-containment. Existing clinical recommendations lack specific guidance to patients and clinicians regarding SMBG practice intensity and frequency, particularly for those patients not treated with insulin. Previous studies of the association between SMBG and glycemic control often found weak and conflicting results.
A reexamination of the role of SMBG is needed, with special attention to the unique needs of patients using different diabetes treatments, within special clinical subpopulations, and during initiation of SMBG versus its ongoing use. Further understanding of the intensity and frequency of SMBG needed to reflect the variability in glycemic patterns would facilitate more specific guideline development. Educational programs that focus on teaching patients the recommended SMBG practice, specific glycemic targets, and appropriate responses to various blood glucose readings would be beneficial. Continuing medical education programs for health-care providers should suggest ways to analyze patient SMBG records to tailor medication regimens. For transfer or communication of SMBG reports to the clinical staff, a standardized format that extracts key data elements and allows quick review by health-care providers would be useful. Because the practice of SMBG is expensive, the cost-effectiveness of SMBG needs to be carefully assessed.
探讨血糖自我监测（SMBG）在糖尿病管理中的作用。
回顾当前趋势及已发表的证据。
尽管有广泛证据表明降低血糖水平可降低糖尿病患者并发症风险，但近年来美国和欧洲患者的血糖控制情况改善甚微。虽然SMBG已被广泛使用，但其在实现血糖控制方面的作用仍存在诸多争议。试纸成本高昂，这使得确定SMBG的适当建议成为当务之急，尤其是在当前医疗成本控制的大环境下。现有的临床建议在SMBG的实践强度和频率方面，缺乏针对患者和临床医生的具体指导，特别是对于那些未接受胰岛素治疗的患者。以往关于SMBG与血糖控制之间关联的研究结果往往微弱且相互矛盾。
需要重新审视SMBG的作用，尤其要关注使用不同糖尿病治疗方法的患者、特殊临床亚群以及开始SMBG与持续使用SMBG时的独特需求。进一步了解反映血糖模式变异性所需的SMBG强度和频率，将有助于制定更具体的指南。专注于教导患者推荐的SMBG实践、特定血糖目标以及对各种血糖读数的适当应对措施的教育项目将是有益的。针对医疗保健提供者的继续医学教育项目应提出分析患者SMBG记录以调整药物治疗方案的方法。为了将SMBG报告传输或传达给临床工作人员，一种提取关键数据元素并允许医疗保健提供者快速查看的标准化格式将很有用。由于SMBG的实践成本高昂，需要仔细评估其成本效益。
