Identifying variables associated with inaccurate self-monitoring of blood glucose: proposed guidelines to improve accuracy.
This study was conducted to evaluate patients' proficiency in self-monitoring of blood glucose (SMBG).



Diabetes nurse educators in 4 suburban Minneapolis clinic sites surveyed the SMBG training/cure practices of 280 patients with type 1 and type 2 diabetes. Participant SMBG technique was measured by direct observation. Participants performed a finger puncture and used their own meters to measure the first blood sample. A second sample was measured on the HemoCue B Glucose analyzer, and a third sample was used to measure hemoglobin. The series of tests were then repeated. If either of the 2 glucose tests was more than 15% from the HemoCue value, participants were reeducated about the manufacturer's suggested procedure.



Of the 280 participants, 19% had blood glucose test results greater than the 15% limit for meter accuracy. After reeducation, 69% of those who had initially failed achieved acceptable results. The most significant problems were lack of periodic meter technique evaluation, difficulty using wipe meters, incorrect use of control solutions, lack of hand washing even when observed, and unclean meters.



As a result of the study, guidelines were subsequently developed to evaluate meter accuracy in an outpatient setting. Further effort is needed to establish standards for evaluating SMBG.
Bergenstal
R
R
The International Diabetes Center, Park Nicollet Institute, Minneapolis (Dr Bergenstal and Mss Pearson, Bina, Davidson, and List)
Pearson
J
J
The International Diabetes Center, Park Nicollet Institute, Minneapolis (Dr Bergenstal and Mss Pearson, Bina, Davidson, and List)
Cembrowski
G S
GS
The Department of Laboratory Medicine and Pathology, University of Alberta, and Capital Health Authority, Edmonton, Alberta, Canada (Dr Cembrowski)
Bina
D
D
The International Diabetes Center, Park Nicollet Institute, Minneapolis (Dr Bergenstal and Mss Pearson, Bina, Davidson, and List)
Davidson
J
J
The International Diabetes Center, Park Nicollet Institute, Minneapolis (Dr Bergenstal and Mss Pearson, Bina, Davidson, and List)
List
S
S
The International Diabetes Center, Park Nicollet Institute, Minneapolis (Dr Bergenstal and Mss Pearson, Bina, Davidson, and List)
D000465:Algorithms; D015982:Bias; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D001800:Blood Specimen Collection / Q000379:methods / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D003663:Decision Trees; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000517:prevention & control; D016640:Diabetes, Gestational / Q000097:blood* / Q000517:prevention & control; D004868:Equipment Failure; D005215:Fasting; D005260:Female; D006235:Hand Disinfection / Q000592:standards; D006801:Humans; D008283:Maintenance; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy; D011795:Surveys and Questionnaires