In this guide to meters on the U.S. market, we’ve listed information that will help you sort through their features. Some important things to consider:

Cost. For the first time, we’ve listed the manufacturers’ suggested retail price (MSRP) of meters and test strips. While your actual costs may vary (because of private insurance, Medicare or Medicaid, coupons, or manufacturer-sponsored savings programs), we believe knowing the retail price is important—especially if you find yourself paying full price for strips. Retail prices vary for many reasons, including the purchasing power of various retailers, regional shipping costs, and the profit margin of the manufacturer. Despite our polite request, some companies declined to provide MSRP information.

Function. The best meter for you is the one that you actually will use regularly—and that enhances your daily diabetes care. That’s where user-friendly extras matter. Almost all meters on the market today are “auto-code” or “no-code,” so you don’t have to enter a code number or use a plastic “key” for each vial of test strips. Other functions that you might find helpful include a backlight (which illuminates the meter’s screen in the dark), audio (useful for those with low or no vision), computer download capability (makes storing, sharing, and analyzing results easy), and attached strip drums or disks (so there’s no need to handle tiny, slippery individual test strips).

Size. There’s a wide range of sizes on the market. Consider what’s most important to you. Think about factors such as your eyesight, the desire to be discreet, the average size of your pocket or purse, and whether you have arthritic fingers and may need widely spaced buttons or strips that come in a vial.

Memory. Most meters save between 100 and 450 test results, though a few record more than 1,000. Some meters offer enhanced note-taking that allows you to enter food, exercise, and medication information for a fuller picture of what’s contributing to your glucose levels.

If you plan to download results to your computer and create reports, consider the meter’s data management software and operating system compatibility. If you’re uncertain about how high tech to go, ask your doctor or diabetes educator what sort of data management might be useful for the way you treat your diabetes. For example, will your health care provider download the data from your meter if you bring it to your appointment?

Accuracy. This is many people’s top concern when choosing a meter. And yet, we don’t report it in this guide. Independent accuracy testing is expensive, complicated, and rare. Diabetes Forecast, for example, doesn’t test or recommend products because the American Diabetes Association is a nonprofit organization without a laboratory or expertise in lab comparisons of products. Where the data do exist, in the form of manufacturers’ tests, accuracy is reported in different ways. Some companies report accuracy as a “regression line,” involving correlation coefficients, slopes, and Y-axes. Others report in a friendlier table format using percentages.

Those measures of accuracy are apples and oranges. “It’s not possible [for a consumer] to do a direct comparison of how accurate one meter is to another,” says Katie Serrano, supervisory biologist and diabetes branch chief at the Food and Drug Administration’s Center for Devices and Radiological Health. “We’ve seen cases where cheaper meters don’t necessarily have all the bells and whistles, but have better accuracy.” She says users have to evaluate all of the features that are important to them.

That said, all meters on the U.S. market are held to a certain standard before the FDA approves them for sale. The FDA uses guidelines set by the International Organization for Standardization (ISO)—it sets the bar for products around the world. The most recent standard for blood glucose meter accuracy is ISO Standard 15197, which is expected to be updated early in 2013 (“Meter Accuracy,” right).

If the allowed variance seems like a wide margin, that’s because it is. “It is wide, but [meters are] pretty much at the limits of their technology,” says Donald Powers, PhD, chairman of the technical committee at the ISO. “They’ve tried to make these meters as small and easy to use and painless as possible. There are trade-offs between performance and convenience. Unless these things are painless and convenient, people aren’t going to comply.” Powers says that some meters might be slightly better than others in terms of accuracy, but the minimum standards needn’t limit innovation. Makers can choose to achieve tighter accuracy standards because it’s the right thing to do and/or it makes them more competitive.

The current standards, however, are frustrating for users, including Scott Strumello, 43, of New York City. Strumello has used meters to manage his type 1 diabetes since the 1980s. Not enough has been done to make meters more accurate, he complains, nor have consumers been given the information they need to make comparisons of meters. “There’s sort of a lot of wiggle room in the standards, even at the new tighter standards [expected in 2013],” he says. “They don’t get as specific as I’d like to see them” in mandating greater accuracy at potentially dangerous high and low glucose levels. The American Diabetes Association forms part of coalitions that advocate tighter international and FDA accuracy standards.

Testing a meter’s accuracy requires a controlled laboratory setting and at least hospital-grade equipment. It must be done without human error—something that’s difficult to control in real-world glucose monitoring, no matter how diligent you are. Karen Roberts, director of design quality for diabetes care research and development at Roche, explains that because all meters conform to ISO standards, they meet accuracy requirements in a perfect setting. The real world, she says, is quite different. “You’ve got an accurate system, but how you use those results to better manage your diabetes, I think, is key,” Roberts adds. “[Laboratory accuracy is only] 5 percent of a system; you still have to use [the meter] properly as well.”

Even with perfect use, Roberts says, you can’t scientifically gauge the accuracy of one personal meter against another. Because users are not in a laboratory setting, they can’t know how accurate the “control” meter is—a legitimate accuracy test must have a control meter or lab machine; your favorite meter is not a good control because you can’t calibrate it. 

Yet if you want to look at accuracy when choosing a meter, there are a few places to turn. Consumer Reports ranks 21 meters in a brief report in its November 2012 issue, though it doesn’t explain how each was rated. (For accuracy, 10 are rated “excellent,” seven “very good,” and four “good.”) And the FDA posts on its website decision summaries of meters that are approved to go on the market (“FDA Meter Data,” left).

Companies are required to report their meters’ accuracy in the devices’ instruction manuals and in the package insert that comes with test strips—many of these are also online. Still, practical experience often trumps the elusive accuracy data—talk to your health care providers about what brands they prefer and what might work best for you.

Even though no meter is 100 percent accurate, looking at a range of readings over a long period will help you keep your blood glucose levels in check. “It’s important to remember that no one number is the end-all, be-all,” says Sue Kirkman, MD, professor of medicine at the University of North Carolina. “Blood glucose patterns can keep you on track. Each reading by itself is just a piece of the puzzle. If something seems completely out of line, recheck it.”