Identifying variables associated with inaccurate self-monitoring of blood glucose: Proposed guidelines to improve accuracy

PURPOSE This study was conducted to evaluate patients' proficiency in self-monitori ng of blood glucose (SMBG). METHODS Diabetes nurse educators in 4 suburban Minneapolis clinic sites surveyed th e SMBG training/cure practices of 280 patients with type 1 and type 2 diabe tes. Participant SMBG technique was measured by direct observation. Partici pants 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 a nalyzer, and a third sample was used to measure hemoglobin. The series of t ests were then repeated. If either of the 2 glucose tests was more than 15% from the HemoCue value, participants were reeducated about the manufacture r's suggested procedure. RESULTS Of the 280 participants, 19% had blood glucose test results greater than th e 15% limit for meter accuracy. After reeducation, 69% of those who had ini tially failed achieved acceptable results. The most significant problems we re lack of periodic meter technique evaluation, difficulty using wipe meter s, incorrect use of control solutions, lack of hand washing even when obser ved, and unclean meters. CONCLUSIONS As a result of the study, guidelines were subsequently developed to evaluat e meter accuracy in an outpatient setting. Further effort is needed to esta blish standards for evaluating SMBG.