Home blood-glucose monitoring: a new approach to the management of diabetes mellitus.

The results in 116 diabetics who were performing long-term home blood-glucose monitoring (HBGM) are presented. By means of Dextrostix and portable glucose meters at home and at work, patients recorded blood glucose (BG) profiles during original treatment and subsequent adjustment, and were followed up for four to 18 months. Initially marked fluctuations in BG levels occurred, with 67% of patients demonstrating hypoglycaemia (clinically silent in 53%) followed by rebound hyperglycaemia (the Somogyi effect). Adjustment of the insulin regimen resulted in reduction in standard deviation of BG concentration from a mean of 4.4 mmol/L to 2.7 mmol/L (P less than 0.001), thus avoiding both hypoglycaemia and extreme hyperglycaemia. Daily insulin dose decreased from a mean of 44 (+/- 21 SD) units to 30 (+/- 12 SD) units per day (P less than 0.001), and the insulin regimens used are described. The results of urine tests correlated poorly with those of HBGM in 67% of patients. Patient acceptance of HBGM was excellent, and it has permanently replaced urine testing in 96% of the subjects. Management based on HBGM resulted in improved diabetic control and life-style, and reduced the frequency of hospital admissions. The need for adequate education in technique and supervision is stressed. HBGM is superior to, and more acceptable than, urine testing as a method of monitoring diabetic control.