Community Pharmacy-Based Intervention to Improve Self-Monitoring of Blood Glucose in Type 2 Diabetic patients

  • Uta Müller
  • Andrea Hammerlein
  • Annette Casper
  • Martin Schulz
Keywords: Diabetes mellitus, Blood glucose self-monitoring, Patient education, Community pharmacy services, Germany


Self-monitoring of blood glucose (SMBG) is clearly correlated with increased life expectancy and quality of life in type 2 diabetic patients.

Objective: The objective of our study was to record and assess the errors patients make in preparing, performing, and processing self-monitoring of blood glucose (SMBG). Furthermore, the study aimed to determine to what extent a single standardized SMBG instruction session in a community pharmacy might reduce the number of patients making errors or the number of errors per patient.

Methods: Between May and October 2005, SMBG of 462 randomly selected patients with type 2 diabetes was monitored in 32 pharmacies specialized in diabetes care. The patients performed blood glucose self-tests using their own blood glucose meters. Self-testing was monitored using a standardized documentation sheet on which any error made during the performance of the test was recorded. If necessary, patients were instructed in the accurate operation of their meter and the use of the necessary equipment. Additionally, patients obtained written instructions. Six weeks later, assessment of the quality of patient’s SMBG was repeated.

Results: During the first observation, 383 patients (83%) made at least one mistake performing SMBG. By the time of the second observation, this frequency had fallen to 189 (41%) (p<0.001). The average number of mistakes fell from 3.1 to 0.8 per patient. Mistakes that may potentially have led to inaccurate readings were initially recorded for 283 (61%) and at study end for 110 (24%) patients (p<0.001).

Conclusion: It is important to periodically instruct type 2 diabetic patients in the proper SMBG technique in order to ensure accurate measurements. In this study it was shown that community pharmacies specialized in diabetes care can provide this service effectively.


Download data is not yet available.


1. Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care 2001; 24(3):561-87.

2. Panja S, Starr B, Colleran KM. Patient knowledge improves glycemic control: is it time to go back to the classroom? J Investig Med 2005; 53(5):264-6.

3. Hauner H. [Evicende based therapy of obesity]. Internist 2006; 47(2):159-70.

4. Keers JC, Bouma J, Links TP et al. One-year follow-up effects of diabetes rehabilitation for patients with prolonged self-management difficulties. Patient Educ Couns 2006; 60(1):16-23.

5. Schiel R, Voigt U, Ross IS, Braun A, Rillig A, Hunger-Dathe W, Stein G, Muller WA. Structured diabetes therapy and education improves the outcome of patients with insulin treated diabetes mellitus. The 10 year follow-up of a prospective, population-based survey on the quality of diabetes care (the JEVIN Trial). Exp Clin Endocrinol Diabetes 2006; 114(1):18-27.

6. Sonksen PH, Judd SL, Lowy C. Home monitoring of blood-glucose. Method for improving diabetic control. Lancet 1978; 1(8067):729-32.

7. Walford S, Gale EA, Allison SP, Tattersall RB. Self-monitoring of blood-glucose. Improvement of diabetic control. Lancet 1978; 1(8067):732-5.

8. Karter AJ, Ackerson LM, Darbinian JA, D’Agostino RB Jr, Ferrara A, Liu J, Selby JV. Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry. Am J Med 2001; 111(1):1-9.

9. Schiel R, Muller UA, Rauchfub J, Sprott H, Muller R. Blood-glucose self-monitoring in insulin treated type 2 diabetes mellitus a cross-sectional study with an intervention group. Diabetes Metab 1999; 25(4):334-40.

10. Schwedes U, Siebolds M, Mertes G. Meal-related structured self-monitoring of blood glucose: effect on diabetes control in non-insulin-treated type 2 diabetic patients. Diabetes Care 2002; 25(11):1928-32.

11. Dreyer M, Kiess W, Lüdecke H, Redaélli M, Schatz H, Waldhäusl W. Therapie des Diabetes mellitus Typ 1. Evidenzbasierte Diabetes-Leitlinie DDG. Scherbaum WA, Landgraf R (eds.). Diabetes und Stoffwechsel 2003; 12 (Suppl. 2).

12. Häring H, Joost H, Laube H, Matthaei S, Meissner HP, Panten U, Schernthaner G. Antihyperglykämische Therapie des Diabetes mellitus Typ 2. Evidenzbasierte Diabetes-Leitlinie DDG. Scherbaum WA, Landgraf R (eds.). Diabetes und Stoffwechsel 2003; 12 (Suppl. 2):13-31.

13. Faas A, Schellevis FG, Van Eijk JT. The efficacy of self-monitoring of blood glucose in NIDDM subjects. A criteria-based literature review. Diabetes Care 1997; 20(9):1482-6.

14. Fontbonne A, Billault B, Acosta M, Percheron C, Varene P, Besse A, Eschwege E, Monnier L, Slama G, Passa P. Is glucose self-monitoring beneficial in non-insulin-treated diabetic patients? Results of a randomized comparative trial. Diabete Metab 1989; 15(5):255-60.

15. Franciosi M, Pellegrini F, De Berardis G, Belfiglio M, Cavaliere D, Di Nardo B, Greenfield S, Kaplan SH, Sacco M, Tognoni G, Valentini M, Nicolucci A, QuED Study Group. The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies. Diabetes Care 2001; 24(11):1870-7.

16. Harris MI. Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Diabetes Care 2001; 24(6):979-82.

17. Muchmore DB, Springer J, Miller M. Self-monitoring of blood glucose in overweight type 2 diabetic patients. Acta Diabetol 1994; 31(4):215-9.

18. Rindone JP, Austin M, Luchesi J. Effect of home blood glucose monitoring on the management of patients with non-insulin dependent diabetes mellitus in the primary care setting. Am J Manag Care 1997; 3(9):1335-8.

19. Martin S, Schneider B, Heinemann L, Lodwig V, Kurth HJ, Kolb H, Scherbaum WA. Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study. Diabetologia 2006; 49(2):271-8.

20. Bundesärztekammer. Richtlinie der Bundesärztekammer (BÄK) zur Qualitätssicherung quantitativer laboratoriumsmedizinischer Untersuchungen. Dtsch Ärztebl 2001; 98:A 2747-59.

21. Thomas A, Hasche H. Anforderungen an die Blutzuckermessgeräte. In: Selbstkontrolle bei Diabetes. Mainz: Kirchheim-Verlag; 2003: 39-42.

22. Alto WA, Meyer D, Schneid J, Bryson P, Kindig J. Assuring the accuracy of home glucose monitoring. J Am Board Fam Pract 2002; 15(1):1-6.

23. Delamater AM, Davis SG, Bubb J, Santiago JV, Smith JA, White NH. Self-monitoring of blood glucose by adolescents with diabetes: technical skills and utilization of data. Diabetes Educ 1989; 15(1):56-61.

24. Kabadi UM, O'Connell KM, Johnson J, Kabadi M. The effect of recurrent practice at home on the acceptability of capillary blood glucose readings. Accuracy of self blood glucose testing. Diabetes Care 1994; 17(10):1110-23.

25. Kristensen GB, Nerhus K, Thue G, Sandberg S. Standardized evaluation of instruments for self-monitoring of blood glucose by patients and a technologist. Clin Chem 2004; 50(6):1068-71.

26. Kristensen GB, Nerhus K, Thue G, Sandberg S. Results and feasibility of an external quality assessment scheme for self-monitoring of blood glucose. Clin Chem 2006; 52(7):1311-7.

27. Schrot RJ, Foulis PR, Morrison AD, Farese RV. A computerized model for home glucose monitoring proficiency testing: efficacy of an innovative testing program. Diabetes Educ 1999; 25(1):48-55.

28. Skeie S, Thue G, Nerhus K, Sandberg S. Instruments for self-monitoring of blood glucose: comparisons of testing quality achieved by patients and a technician. Clin Chem 2002; 48(7):994-1003.

29. Ward WK, Haas LB, Beard JC. A randomized, controlled comparison of instruction by a diabetes educator versus self-instruction in self-monitoring of blood glucose. Diabetes Care 1985; 8(3):284-6.

30. Bergenstal R, Pearson J, Cembrowski GS, Bina D, Davidson J, List S. Identifying variables associated with inaccurate self-monitoring of blood glucose: proposed guidelines to improve accuracy. Diabetes Educ 2000; 26(6):981-9.

31. Dorchy H, Van Vlaenderen C, Roggemans MP. [Sources of errors in blood glucose self-monitoring in 100 young diabetics]. Rev Med Brux 2003; 24(2):77-81.

32. Perwien AR, Johnson SB, Dymtrow D, Silverstein J. Blood glucose monitoring skills in children with Type I diabetes. Clin Pediatr 2000; 39(6):351-7.

33. American Diabetes Association. Self-monitoring of blood glucose. Diabetes Care 1990; 13(Supplement 1):S62-6.

34. American Diabetes Association. Tests of glycemia in diabetes. Diabetes Care 2004; 27 [Supplement]:S91-3.

35. Eickhoff C, Schulz M. Einbindung der Apotheker in die Diabetikerversorgung. Pharm Ztg 2000; 145(7):512-4.

36. Krüger M. MessTest-Aktion.Personal communication, 2002.

37. Mangiapane S; Schulz M; Muhlig S; Ihle P; Schubert I; Waldmann H C. Community pharmacy-based pharmaceutical care for asthma patients. Ann Pharmacother 2005; 39(12):1817-22.

38. Meadows S. Improving blood glucose monitoring for diabetes. FDA Consum 1990; May.

39. Steel LG. Identifying technique errors. Self-monitoring of blood glucose in the home setting. J Gerontol Nurs 1994; 20(2):9-12.

40. Gerdemann A, Müller U, Schulz M. Akzeptanz und Evaluation der zertifizierten Diabetes-Fortbildung. Pharm Ztg 2004; 149(46):4052-4.

41. Krüger M. Stufenkonzept: Diabetische Patienten qualifizierter betreuen. Pharm Ztg 2000; 145(45):3812-4.

42. Müller U, Hämmerlein A, Schulz M. Blutzucker fehlerfrei selbst bestimmen. Pharm Ztg 2005; 150(38):3396-7.
Original Research