The EAL is seeking RDNs and NDTRs who work with patients, clients, or the public to treat children and adolescents living with type 1 diabetes, for participation in a usability test and focus group. Interested participants should email a professional resume to by July 15, 2024.

Recommendations Summary

DM: Education on Glucose Monitoring (2015)

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

  • Recommendation(s)

    DM: Education on Glucose Monitoring

    The registered dietitian nutritionist (RDN) should ensure that adults with type 1 diabetes and type 2 diabetes are educated about glucose monitoring and using data to adjust therapy. When prescribed as part of a broader educational context, results may help guide treatment decisions and self-management. 


    Rating: Fair

    • Risks/Harms of Implementing This Recommendation


    • Conditions of Application


    • Potential Costs Associated with Application

      Costs of medical nutrition therapy (MNT) sessions and reimbursement vary; however, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      From the 2015 American Diabetes Association Standards of Medical Care in Diabetes

      Glycemic Targets

      • When prescribed as part of a broader educational context, SMBG results may help guide treatment decisions and self-management for patients using less frequent insulin injections (Grade B) or non-insulin therapies. Grade E
      • When prescribing SMBG, ensure that patients receive ongoing instruction and regular evaluation of SMBG technique, SMBG results and their ability to use SMBG data to adjust therapy. Grade E
      • Patients on multiple-dose insulin or insulin pump therapy should perform SMBG prior to meals and snacks, occasionally post-prandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normo-glycemic, and prior to critical tasks such as driving. Grade B
      • When used properly, CGM in conjunction with intensive insulin regimens is a useful tool to lower A1C in selected adults (aged 25 years or older) with type 1 diabetes. Grade A
      • Although the evidence for A1C lowering is less strong in children, teens and younger adults, CGM may be helpful in these groups. Success correlates with adherence to ongoing use of the device. Grade B
      • CGM may be a supplemental tool to SMBG in those with hypoglycemia unawareness and frequent hypoglycemic episodes. Grade C
      • Given variable adherence to CGM, assess individual readiness for continuing use of CGM prior to prescribing. Grade E
      • When prescribing CGM, robust diabetes education, training and support are required for optimal CGM implementation and ongoing use. Grade E
      • Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). Grade E
      • Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. Grade E
      • Use of point-of-care testing for A1C provides the opportunity for more timely treatment changes. Grade E
      • Lowering A1C to approximately 7% or less has been shown to reduce microvascular complications of diabetes, and, if implemented soon after the diagnosis of diabetes, it is associated with long-term reduction in macrovascular disease. Therefore, a reasonable A1C goal for many non-pregnant adults is less than 7%. Grade B
      • Providers might reasonably suggest more stringent A1C goals (such as less than 6.5%) for selected individual patients if this can be achieved without significant hypoglycemia or other adverse effects of treatment. Appropriate patients might include those with short duration of diabetes, type 2 diabetes treated with lifestyle or metformin only, long life expectancy or no significant cardiovascular disease (CVD). Grade C
      • Less stringent A1C goals (such as less than 8%) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive co-morbid conditions or long-standing diabetes in whom the general goal is difficult to attain despite diabetes self-management education, appropriate glucose monitoring and effective doses of multiple glucose-lowering agents including insulin. Grade B
      • Individuals at risk for hypoglycemia should be asked about symptomatic and asymptomatic hypoglycemia at each encounter. Grade C
      • Glucose (15g to 20g) is the preferred treatment for the conscious individual with hypoglycemia, although any form of carbohydrate that contains glucose may be used. Fifteen minutes after treatment, if SMBG shows continued hypoglycemia, the treatment should be repeated. Once SMBG returns to normal, the individual should consume a meal or snack to prevent recurrence of hypoglycemia. Grade E
      • Glucagon should be prescribed for all individuals at an increased risk of severe hypoglycemia, and caregivers or family members of these individuals should be instructed on its administration. Glucagon administration is not limited to health care professionals. Grade E
      • Hypoglycemia unawareness or one or more episodes of severe hypoglycemia should trigger re-evaluation of the treatment regimen. Grade E
      • Insulin-treated patients with hypoglycemia unawareness or an episode of severe hypoglycemia should be advised to raise their glycemic targets to strictly avoid further hypoglycemia for at least several weeks in order to partially reverse hypoglycemia unawareness and reduce risk of future episodes. Grade A
      • Ongoing assessment of cognitive function is suggested with increased vigilance for hypoglycemia by the clinician, patient and caregivers if low cognition or declining cognition is found. Grade B
      Older Adults
      • Older adults who are functional and cognitively intact and have significant life expectancy should receive diabetes care with goals similar to those developed for younger adults. Grade E
      • Glycemic goals for some older adults might reasonably be relaxed, using individual criteria, but hyperglycemia leading to symptoms or risk of acute hyperglycemic complications should be avoided in all patients. Grade E

    • Recommendation Strength Rationale

      The 2015 American Diabetes Association Standards of Medical Care in Diabetes received Grades A, B, C and E.

    • Minority Opinions

      Consensus reached.