A Rosetta Stone for Insulin Treatment: Self-Monitoring of Blood Glucose (Editorial‪)‬

In the daily management of type 1 diabetes, self-monitoring of blood glucose (SMBG) is the recommended glycemic monitor, or "Rosetta stone", that enables improved glycemic control (1). By measuring real-time glucose, informed patients can modify their diabetes management acutely or prospectively to sustain glucose in a narrow range near normal. A recent study from the Veterans Administration demonstrated improved glycemic control with lowered hemoglobin [A.sub.1c] in patients with insulin-treated type 2 diabetes who performed SMBG (2). A wide range of insulins is now available with various durations of action that can help to improve glycemic control. The greatest therapeutic advances entail the use of recombinant DNA-engineered insulin analogs. Novel insulins such as lyspro-insulin [lysine(B28), proline(B29)] have a very rapid onset of action (15-30 min), peak effect (1-2 h), and limited overall duration of action (3-4 h), whereas glargine ([sup.A]-Gly-30[sup.B]a-L-Arg-[sup.30]Bh-L-Arg-human) has no peak and a duration of action of 24 h or longer. Maintaining blood glucose at or very near the normal range decreases the frequency of new-onset microvascular complications and delays the progression of established microvascular complications in both type 1 and type 2 diabetes (3-5). In non-insulin-treated patients, before 2002 there were few data to suggest that SMBG improved clinical outcome (6). However a recent study from France found that SMBG lowered hemoglobin [A.sub.1c] in monitored, non-insulin-treated type 2 diabetes (7), as did a study from Germany (8).