Based on scientific evidence and long-standing clinical experience, self-monitoring of blood glucose (SMBG) is recommended for people with diabetes, regardless of the type of medication or therapy they use. These therapies include:
These recommendations apply to different types of diabetes:
type 1 diabetes, type 2 diabetes using insulin, gestational diabetes, pancreoprivic diabetes, and other diabetes forms.
Particular importance of SMBG when hypoglycemia is possible
SMBG is especially indicated for people taking medications that can lead to hypoglycemia, in particular:
SMBG is also essential for anyone on flexible insulin therapy (ICT, CSII, or supplementary insulin therapy – SIT), because meal-time insulin dosing requires a blood glucose test before meals, and insulin doses must be adapted to the current blood glucose level and the amount of carbohydrates eaten.
SMBG in type 2 diabetes without insulin
For people with type 2 diabetes treated with non-insulinotropic oral antidiabetic medications, SMBG is particularly important during the initial treatment phase.
Once blood glucose control is stable, occasional measurements may be helpful to obtain an overview of the current metabolic situation.
Measurements are also recommended for all people with diabetes in special situations, such as:
Patients with type 2 diabetes managed by diet alone may also perform occasional measurements to gain insight into their glucose levels.
Coverage of test strips
For people with type 2 diabetes not treated with insulin, the cost of test strips is generally covered only in exceptional cases.
In these cases, a maximum of 50 test strips per quarter can be prescribed, such as:
How often should blood glucose be measured?
The frequency of SMBG depends on the type of therapy, especially in patients who do not use continuous glucose monitoring (CGM) for therapy support or automated insulin delivery (AID) systems.
People using CGM still need to perform occasional blood glucose measurements, for example:
Detailed recommendations can be found in the practice guidelines of the German Diabetes Association (DDG/AGDT).
SMBG in ICT and insulin pump therapy
Intensified Conventional Therapy (ICT)
People with type 1 diabetes on ICT should:
Insulin Pump Therapy (CSII)
People using CSII need additional measurements due to the increased risk of severe hyperglycemia or diabetic ketoacidosis (DKA), since pump therapy uses exclusively rapid-acting insulin.
Extra measurements are needed:
Test strip requirements in ICT and CSII
Type 2 diabetes with ICT
The same rules apply as for type 1 diabetes:
Typical test strip requirement:
at least 4–5 per day (≥500 per quarter)
Type 2 diabetes with CT or BOT
Type 2 diabetes using insulinotropic oral agents
(sulfonylureas, glinides)
Non-insulinotropic oral therapy / GLP-1 RA / dual GLP-1/GIP agonists
Pregnancy
Pregnant women with pre-existing type 1 or type 2 diabetes
They need:
Gestational diabetes
Patient group | Recommended SMBG frequency
Type 1 diabetes or type 2 diabetes using insulin
Frequent testing (multiple times per day: e.g., before and after meals, before bedtime, and occasionally at night)
Type 2 diabetes without insulin, stable glycemic control
Testing is not required daily; optional monitoring 2–3 days per week or during therapy changes/problems
Type 2 diabetes without insulin, with therapy change or unstable control
More frequent testing is useful to guide therapy adjustments
Detailed ADA Recommendations
No. | Recommendation (original quote) | Evidence grade | Comment / translation |
6.1 | “Assess glycemic status (A1C or other glycemic measurement such as time in range or glucose management indicator) at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control).” | E | Goal: For stable patients achieving their targets, assess glycemia at least twice per year. |
6.2 | “Assess glycemic status at least quarterly and as needed in patients whose therapy has recently changed and/or who are not meeting glycemic goals.” | E | If therapy changes or targets are not met: assess glycemia quarterly or more often. |
6 (general) | “Individual glucose monitoring (discussed in detail in Section 7, ‘Diabetes Technology’) is a useful tool for diabetes self-management … particularly in individuals taking insulin.” | — | Emphasizes: glucose self-monitoring is a useful tool, especially for people on insulin. |
7.6 | “People with diabetes should be provided with blood-glucose monitoring (BGM) devices as indicated by the individual’s treatment regimen and need.” | E | Recommendation: people with diabetes should receive BGM devices according to therapeutic need. |
7.12 (rephrased) | “For adults with type 2 diabetes treated with basal insulin, intermittently scanned CGM may be considered; real-time CGM should be offered when available.” (paraphrased) | B | Specific for type 2 diabetes on basal insulin: consider CGM when available. |
7.x (children/youth) | “RT-CGM (real-time continuous glucose monitoring) or is-CGM (intermittently scanned CGM) should be offered for youth with type 1 diabetes treated with multiple daily injections or insulin pump therapy.” | A | For youth with type 1 diabetes and intensive insulin therapy: CGM must be offered. |
Explanation of evidence grades (ADA system)
Notes on practical application
[1] Schlüter S, Deiss D, Gehr B, Lange K, von Sengbusch S, Thomas A, Ziegler R, Freckmann G. Glucose measurement and monitoring in patients with type 1 or type 2 diabetes. Diabetol. und Stoffwechsel 2023; 18 (Suppl 2): S114–S135. DOI: 10.1055/a-2075-9968.
[2] ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, et al. 6. Glycemic Targets: Standards of Care in Diabetes–2023. Diabetes Care. 2023 Jan 1;46(Suppl 1):S97–S110. doi: 10.2337/dc23-S006. PMCID: PMC9810469.
[3] American Diabetes Association Professional Practice Committee. 7. Diabetes Technology: Standards of Care in Diabetes—2025. Diabetes Care. 1 January 2025; 48(Suppl 1): S146–S166. https://doi.org/10.2337/dc25-S007.