More frequent BGM is also needed during acute illness or times of stress. For people who have hypoglycemia unawareness, performing BGM before activities that require clear cognition (e.g., driving, caring for children, or operating heavy machinery) should be the norm. Other times people with type 1 diabetes should check their blood glucose level include before exercise, during prolonged exercise, occasionally after meals, and whenever they have signs or symptoms of hypoglycemia. At a minimum, it is recommended that people with type 1 diabetes who are not using CGM perform BGM 4 times/day (before meals and at bedtime). Given the day-to-day glycemic variability that people with type 1 diabetes typically experience, recommended BGM frequency per day will vary by person and anticipated daily activities. Likewise, a study of a meter that displayed color-coded glucose range data (in addition to a glucose value) demonstrated a salutary effect, particularly in people with low numeracy ( 25). This approach allows a mobile app to photograph a glucose strip and provide an estimated glucose level range, rather than a specific value, and does not require users to purchase a meter. In recognition of this, one major manufacturer of meters introduced a semi-quantitative system using a smartphone camera ( 24). However, people with type 2 diabetes who are not taking medications likely to cause hypoglycemia may accrue benefit even from less-expensive devices with lower accuracy ratings. Type 1 diabetes, pregnancy, and use of a CGM device that benefits from calibration are all compelling examples of circumstances requiring high BGM accuracy. Although it may seem intuitively obvious that more accurate BGM is advantageous, access to any means of BGM is such a formidable barrier in low-resource settings ( 23) that a broader perspective is needed.
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