The role of self-monitoring of blood glucose in the routine management of children with insulin-dependent diabetes mellitus.

We report a double-crossover study to assess the impact of self-monitoring of blood glucose (SMBG) on the glycemic control of children with insulin-dependent diabetes mellitus (IDDM) on a conventional therapeutic regimen. Sixteen children were assigned to one of two groups--group A, period 1 (wk 1-13): urine testing plus SMBG; period 2 (wk 14-26): urine testing only; group B, period 1: urine only; period 2: urine testing plus SMBG. Frequent telephone contact was maintained throughout to help optimize insulin dose adjustment. At the outset, the two groups were similar in age, diabetes duration, and glycosylated hemoglobin levels (10.5 +/- 0.6% and 9.5 +/- 0.3% in groups A and B, respectively). No significant differences could be detected between the two groups at any stage of the study. There was, however, a trend toward lower mean blood glucose (MBG) concentration in both groups toward the end of the SMBG period. No complications of SMBG were noted, but compliance was a major problem in three children. SMBG confirmed symptoms of hypoglycemia in all children, and detected asymptomatic hypoglycemia (BG less than or equal to 40 mg/dl) in 11. Sixty-nine percent preferred SMBG to urine testing. We conclude that SMBG is an acceptable part of routine diabetes care in children. It is associated with very few complications and helps to confirm symptomatic hypoglycemia and detect asymptomatic hypoglycemia. However, the addition of SMBG to routine diabetes care does not necessarily lead to improved metabolic control.