Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes
Open accessAbstract
The aim of this study was to correlate the frequency of self-monitoring of blood glucose (SMBG) to the quality of metabolic control as measured by hemoglobin A1c (HbA1c), the frequency of hypoglycemia and ketoacidosis, and to see whether the associations between SMBG and these outcomes are influenced by the patient's age or treatment regime. We analyzed data from the DPV-Wiss-database of 26 723 children and adolescents aged 0-18 yr with type 1 diabetes recorded during 1995-2006. Variables evaluated were gender, age at visit, diabetes duration, therapy regime, insulin dose, body mass index-standard deviation scores (BMI-SDS), HbA1c, rate of hypoglycemia, and ketoacidosis. In the youngest age group of children under the age of 6 yr, the frequency of SMBG was the highest compared with that in children aged 6-12 yr or children aged > 12 yr: 6.0/d vs. 5.3/d vs. 4.4/d (p < 0.001). Frequency of SMBG differed significantly also in the different groups of treatment (p < 0.001), but only for the continuous subcutaneous insulin infusion (CSII) group the frequency was considerably higher: 5.3/d (CSII) vs. 4.7/d (multiple daily injections) vs. 4.6/d (conventional therapy). Adjusted for age, gender, diabetes duration, year of treatment, insulin regimen, insulin dose, BMI-SDS, and center difference, SMBG frequency was significantly associated with better metabolic control with a drop of HbA1c of 0.20% for one additional SMBG per day (p < 0.001). Increasing the SMBG frequency above 5/d did not result in further improvement of metabolic control. A higher frequency of SMBG measurements was related to better metabolic control. But only among adolescents aged > 12 yr, metabolic control (HbA1c) improved distinctively with two or more blood glucose measurements.
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Monitoring of blood glucose less frequently than three to four times per day in adults and adolescents has been associated with less effective control of glycemia as measured by HbA 1c.
“Monitoring of blood glucose less frequently than three to four times per day in adults and adolescents has been associated with less effective control of glycemia as measured by HbA 1c (150)(151)(152).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [151]
The Results report that more frequent monitoring was associated with lower HbA1c, and the Discussion specifies a marked improvement with 2–5 measurements per day among adolescents. The study covers children and adolescents, not adults, and does not establish a specific three-to-four-times-per-day threshold. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn a study of individuals under 18 years of age with type 1 diabetes, the frequency of BGM was found to correlate inversely with HbA 1c and with the incidence of diabetic ketoacidosis.
“In a study of individuals under 18 years of age with type 1 diabetes, the frequency of BGM was found to correlate inversely with HbA 1c and with the incidence of diabetic ketoacidosis (151).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [151]
In a database study of almost 27,000 children and adolescents with type 1 diabetes, after adjusting for multiple confounders, increased daily BGM frequency was significantly associated with lower A1C (0.2% per additional check per day) and fewer acute complications.
“A database study of almost 27,000 children and adolescents with type 1 diabetes showed that, after adjusting for multiple confounders, increased daily frequency of BGM was significantly associated with lower A1C levels (À0.2% per additional check per day) and with fewer acute complications (29).”
From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [29]
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- Authors
- Ziegler, R., Heidtmann, B., Hilgard, D., Hofer, S., Rosenbauer, J., Holl, R., & DPV-Wiss-Initiative, F. T.
- Affiliations
- Katholisches Kinderkrankenhaus Wilhelmstift (DE)
- Gemeinschaftskrankenhaus Herdecke (DE)
- Innsbruck Medical University (AT)
- Deutsches Diabetes-Zentrum e.V. (DE)
- Universität Ulm (DE)
- Corresponding author
- Ziegler, Ralph
- Venue
- Pediatric Diabetes
- Publisher
- Wiley
- Published
- 2011-01-25
- Volume
- 12
- Issue
- 1
- Pages
- 11-17
- ISSN
- 1399-543X (ISSN-L)
- OpenAlex
- W1979789349
- Semantic Scholar
- 47af0d8c1d6cad348fbbb847fc610b63101ab610
- Cited by
- 334
- References
- 16
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 13 · 2023: 11 · 2022: 21 · 2021: 35 · 2020: 34 · 2019: 25 · 2018: 32 · 2017: 23 · 2016: 16 · 2015: 29 · 2014: 25 · 2013: 23 · 2012: 19
- FWCI
- 14.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Pediatric Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Gilead Sciences
- Diabetes-Stiftung
- Bundesministerium für Bildung und Forschung (01GI0859)
- Bundesministerium für Gesundheit
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- self-monitoring of blood glucose, type 1 diabetes, children and adolescents, HbA1c, glycemic control, hypoglycemia, diabetic ketoacidosis, insulin pump therapy, multiple daily insulin injections, insulin dose, age differences, diabetes complications
- MeSH terms
- Adolescent, Austria, Blood Glucose, Child, Child, Preschool, Diabetes Mellitus, Type 1, Female, Germany, Glycated Hemoglobin, Humans, Hypoglycemia, Insulin, Male, Blood Glucose Self-Monitoring, Diabetic Ketoacidosis, Treatment Outcome
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