Modern diabetes management requires intensive self-monitoring of blood glucose levels, often coupled with a multicomponent insulin program. Recent advances include alternate site blood glucose testing devices, which facilitate more frequent sampling by individuals with diabetes. Continuous glucose monitoring through interstitial fluid analysis is now available and appears to give a more representative picture of the glycemic variations typical for type 1 diabetes. Recombinant DNA technology has led to the development of new insulin analogs that provide more physiologic insulin delivery. Inhaled and oral insulin formulations may replace multiple injections in future insulin therapy regimens.
The Diabetes Control and Complications Trial and the UK Prospective Diabetes Study have clearly established the benefit of near-normalization of blood glucose levels to reduce the risk of chronic complications in individuals with diabetes mellitus. An integral part of the treatment program for all affected individuals is self-monitoring of blood glucose (SMBG). This requires lancing the fingertip, applying a blood sample to a test strip, and recording the result from a portable meter. Patients must learn problem-solving skills regarding daily events, and health care professionals must be able to accurately interpret glucose data and provide meaningful feedback in the setting of a brief office visit. Patients complain about the discomfort, inconvenience, and expense of testing. Self-reported data are not necessarily a reliable and accurate representation of the patient's true glycemic pattern. However, with the current treatment trends of more flexible diets and complex medication schedules, SMBG is absolutely essential to achieve the ADA standards of glycemic control. For those patients on multicomponent intensive insulin regimens, multiple daily tests both before and after meals are necessary. The quest for noninvasive monitoring and more comprehensive glucose data collection has provided new monitoring technologies to assist the health care professional and the patient. Recombinant DNA technology has facilitated the development of new insulin analogs that provide more physiologic delivery of insulin. These advances will enable more individuals with diabetes to approach optimal glucose control in the future. This discussion will review new glucose monitoring devices, products in development, and the status of new insulin analogs.