[Sources of errors in blood glucose self-monitoring in 100 young diabetics].

Self-monitoring of blood glucose (SMBG) has become increasingly important in the treatment plan of people with diabetes. Identifying sources of error in SMBG can have a significant clinical impact. The objective of the present study was to evaluate the testing skills in diabetic children and adolescents. The study included 100 patients (46 females and 54 males) with an age of 8-18 years and a mean duration of diabetes of 4.5 years. They were autonomous for SMBG: an experienced diabetes nurse had taught earlier how to proceed. The daily frequency of SMBG was 4 in 79 patients, 3 in 11, and 2 in 10. The observations of their performance of blood glucose monitoring skills were done twice, during 2 consecutive visits at the diabetes clinic at a mean interval of 2 months. Each patient was observed by a specialized nurse who scored the child's testing behavior with an observation grid, according to 45 items. After the first observation, children and adolescents were given feedback on the identified errors. The second observation allowed scoring the improvements. During the first observation, nearly 90% of the patients made 3 or more mistakes, 69% more than 5, and 10% more than 10. During the second observation, these frequencies fall to 17, 2, and 0%. The main errors were the following (first vs second observation, in % of patients): not washing hands: 54 vs 3; incorrect setting for hour and date: 47 vs 2, and 17 vs 2; no knowledge of the meaning of "HI" (blood glucose > 500 or 600 mg/dL): 55 vs 3; no knowledge of the meaning of "LO" (< 10 or 20 mg/dL): 49 vs 1; insufficient blood drop: 19 vs 10. Younger children, with a shorter duration of diabetes and of autonomy for SMGB, need closer supervision. Errors were unrelated to frequency of SMBG, and glycated haemoglobin. To conclude, it is important to periodically assess diabetic children and adolescents' SMGB technique in order to correct the mistakes, mainly in younger children. The use of an observation grid allows an accurate analysis of the numerous possible errors.