Development and implementation of signs- and symptoms-based insulin adjustment algorithm

Self-monitoring of blood glucose (SMBG) is an essential tool for optimal diabetes control.1–4 SMBG not only empowers patients to take control of their own glucose levels but also helps health care professionals to evaluate the effectiveness of their patients’ diabetes therapy. SMBG is indicated for all patients using insulin and is recommended for patients whose glycemic goals are not achieved or who have difficulty recognizing the symptoms of hypoglycemia.1,2 The management of diabetes heavily relies on self-monitored blood glucose readings.3,4 However, due to patients’ forgetfulness, pain from skin puncture, inconvenience, and cost, poor adherence to SMBG is still a major problem, especially in ambulatory care settings.4–7 A phenomenon commonly observed in outpatient settings when no blood glucose readings are available is to put the insulin dosage adjustment on hold or to increase the insulin dosage by small increments until the next visit. Because the follow-up visit may occur after a few weeks to a few months, depending on the clinic’s availabilities and patients’ willingness to return to the clinic, diabetes management is often compromised.