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Considering that diaries are used to inform decisions about therapy when HbA1c is raised or in pregnancy, when HbA1c is not suitable, there is significant cause for concern in relation to their clinical utility. The lack of meter-diary agreement suggests that the real reason for monitoring is not understood by many patients, raising issues about motivation, perceived need to impress healthcare providers and denial of poor control.

Those who were younger were more likely to have 'errors', while those who monitored more frequently had more 'accurate' diaries. Agreement was not related to sex, number of insulin injections or duration of monitoring. Disagreements were most extensive in teenagers and young adults, but the pregnant populations were only slightly better. Allowing for a minimal amount of disagreement, just over 50% of adult diaries can be considered as 'accurate/reliable'. When present to a high degree, 'errors' lead to decreased variability in diary records compared with meter records. Failure to record blood glucose measurements in the diary was the most extensive 'error', but addition of values, which were not measured, was a greater cause for concern.

To synthesize evidence relating to comparisons between patient-generated blood glucose records and meter memory in diabetes and to identify any predictors of agreement.Ī systematic literature search was performed to identify articles comparing meter and diary records in those unaware of this assessment.Įleven observational studies, covering patients with Type 1, Type 2 and gestational diabetes were included spanning 1984-2009. To achieve maximum benefit from glucose self-monitoring, glucose meter memory analysis is crucial before making therapy adjustments based on SMBG.

Some inaccuracy might be due to cognitive impairment. SMBG diaries are frequently either not accurate or not brought to clinic visit. A patient's self-assessment of his or her diary's accuracy was unreliable (sensitivity 63%, specificity 56%). An inaccurate glucose diary (by comparison with meter readings) was predicted by normotension (odd ratio 5.6, P = 0.02) and one measure of cognitive impairment, slow Digit Symbol Coding (odds ratio 2.2, P = 0.02). The main outcome measure was accuracy of the glucose diary assessed by comparing reported values to meter memory readings and to results of hemoglobin A(1c).īlood glucose self-monitoring was either missing or misleading for 48% (55 of 115) because (1) patients brought neither meter nor the SMBG diary (n = 26) or (2) the diary was inaccurate (n = 29). Trained interviewers used standard tests to assess literacy, depression, and cognitive function. We collected copies of SMBG diaries and downloaded data from their glucose meters if patients brought them to their clinic appointment. This was a cross-sectional study of adults with type 2 diabetes in a diabetes clinic at a large urban public hospital. The prevalence and predictors of inaccurate self-monitored blood glucose (SMBG) diaries in type 2 diabetes are not well defined.