Errors in self-monitored blood glucose testing and deviations from carbohydrate intake recommendations following initial education for gestational diabetes — ASN Events
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Errors in self-monitored blood glucose testing and deviations from carbohydrate intake recommendations following initial education for gestational diabetes (#122)

Roslyn A Smith 1 2 , Renee Borg 3 , Vincent Wong 1 4 , Hamish Russell 1 4 , Ka Hi Mak 2 4
  1. Liverpool Hospital Diabetes and Endocrine Service, Liverpool, NSW
  2. Dietetics Department, Liverpool Hospital, South West Sydney, NSW
  3. Nutrition and Dietetics, School of Health and Society, University of Wollongong, Wollongong, NSW
  4. University of New South Wales, Sydney, NSW

Background: Gestational diabetes (GDM) management requires substantial daily effort, including dietary changes and self‑monitored blood glucose (SMBG) testing. Clinical decisions often assume correct SMBG technique and adherence to dietary advice, yet real‑world behaviours are shaped by competing lifestyle demands. Over‑restriction of carbohydrate intake (CI) may reduce short‑term hyperglycaemia but introduce longer‑term nutritional risks.

Aims: To assess (1) the prevalence of SMBG errors, (2) deviations from CI recommendations, and (3) reasons for low‑CI episodes during the week after initial GDM group education.

Methods: Women completed detailed food and SMBG diaries for 5–9 days, documenting meal timing, CI amounts, and SMBG timing as per routine care. Group attendees were informed about the study and included unless they opted out. Diary entries were cross‑checked against each participant’s SMBG meter memory. SMBG errors and CI deviations were tallied. Dietitians assessed low‑CI episodes during routine follow‑up and categorised reasons for these as knowledge deficit, short‑term forgetfulness, acute food preferences or lifestyle factors, or intentional restriction to influence blood glucose, health, or weight.

Results: Ninety‑seven women were included; 12 opted out. Median (IQR) age was 32(8) years, BMI 25.1(5.9) kg/m², and 16.5% had prior GDM. Ethnic mix: 30% South Asian, 21% South‑East Asian, 20% Middle Eastern, 14% Anglo‑Australian, 16% other. Sixty‑two percent recorded more than two SMBG errors per week. The most frequent errors were late postprandial tests (33%), missed tests (15%), late fasting tests (14%), and eating between a meal and its paired test (5%). CI deviations included missed snacks (93%), extended daytime fasts (90%), high‑carbohydrate meals (81%), extended overnight fasts (80%), high‑glycaemic‑index meals (60%), and low‑carbohydrate meals (59%). Dietitian assessment attributed most low‑CI episodes to acute food preferences or lifestyle factors (72%), with fewer due to forgetfulness (9%) or knowledge deficits (7%). Intentional restriction accounted for 12%.

Conclusions: SMBG and dietary adherence challenges are common after GDM education. Systems relying solely on SMBG data, such as remote‑monitoring platforms, risk overlooking individuals who appear to have in‑target glycaemia but are doing so through excessive dietary restriction or mis‑timed SMBG tests. More holistic systems are needed to generate accurate risk profiles while minimising consumer burden.