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. 2010;4(2):e102-13.
Epub 2010 May 18.

Efficacy of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin: a systematic review and meta-analysis

Brendan McIntosh, Changhua Yu, Avtar Lal, Kristen Chelak, Chris Cameron, Sumeet R Singh, Marshall Dahl

Efficacy of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin: a systematic review and meta-analysis

Brendan McIntosh et al. Open Med. 2010.

Abstract

Background: Self-monitoring of blood glucose levels is commonly performed by patients with diabetes mellitus. However, there is debate surrounding the clinical utility and cost-effectiveness of this practice among patients with type 2 diabetes managed without insulin. We conducted a systematic review and meta-analysis to determine the effect of self-monitoring versus no self-monitoring, and the optimal frequency of self-monitoring, in this population.

Methods: MEDLINE, EMBASE, BIOSIS Previews, CINAHL and PsycINFO were searched for randomized controlled trials (RCTs) and observational studies published in English from January 1990 to March 2009. Additional citations were obtained through searches of the Internet and conference proceedings, and from stakeholder feedback. Two reviewers independently selected studies, extracted data and performed an assessment of the methodologic quality of the studies. Key outcomes of interest were hemoglobin A1c (HbA(₁c)) concentration, hypoglycemia, quality of life, long-term complications of diabetes and death. Where appropriate, we pooled data using random-effects meta-analysis.

Results: We identified 1624 citations through the literature search and selected 25 articles for inclusion. We observed a statistically significant improvement in the HbA(₁c) concentration across RCTs that compared self-monitoring of blood glucose levels with no self-monitoring among patients taking oral antidiabetes drug therapy (weighted mean difference --0.25%, 95% confidence interval -0.36% to -0.15%). Subgroup analysis indicated that results from RCTs that provided patients with education on how to interpret and apply self-monitoring test results were similar to those from RCTs that did not. On the basis of limited evidence, self-monitoring of blood glucose levels did not demonstrate consistent benefits in terms of quality of life, patient satisfaction, prevention of hypoglycemia or long-term complications of diabetes, or reduction of mortality. There was insufficient evidence pertaining to the optimal frequency of self-monitoring.

Interpretation: Self-monitoring of blood glucose levels was associated with a modest, statistically significant reduction in hemoglobin A1c concentrations, regardless of whether patients were provided with education on how to interpret and use the test results. Further studies are required to determine whether self-monitoring reduces the risk of long-term complications of diabetes and to identify patients most likely to benefit from self-monitoring.

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Conflict of interest statement

Competing interests: Marshall Dahl has received an honorarium of less than $5000 from Eli Lilly Canada Inc. for his work related to workshops. He has also received an arm’s-length grant from GlaxoSmithKline Inc. for a diabetes study involving patients with coronary artery disease. Brendan McIntosh, Changhua Yu, Avtar Lal, Kristen Chelak, Chris Cameron and Sumeet Singh have no personal or financial competing interests related to this project.

Figures

Figure 1
Figure 1
Selection of randomized controlled trials and observational studies on the efficacy of self-monitoring of blood glucose levels in patients with type 2 diabetes mellitus managed without insulin.
Figure 2
Figure 2
Effect of self-monitoring of blood glucose levels versus no self-monitoring on hemoglobin A1c concentration (change from baseline) in adults with type 2 diabetes managed without insulin.
Table 1
Table 1
Effect on hemoglobin A1c (HbA1c) concentrations reported in RCTs comparing self-monitoring of blood glucose levels with no self-monitoring, or various frequencies of self-monitoring, among adults with type 2 diabetes managed without insulin
Table 2
Table 2
Mean differences in hemoglobin A1c (HbA1c) concentrations reported in retrospective cohort studies comparing self-monitoring of blood glucose levels with no self-monitoring, or various frequencies of self-monitoring, among adults with type 2 diabetes managed without insulin
Table 3
Table 3
Effect on overall, severe and nocturnal hypoglycemia reported in RCTs comparing self-monitoring of blood glucose levels with no self-monitoring, or various frequencies of self-monitoring, among adults with type 2 diabetes managed without insulin
Table 4
Table 4
Mean differences in patient satisfaction with diabetes treatment, well-being and quality of life reported in RCTs comparing self-monitoring of blood glucose levels with no self-monitoring among adults with type 2 diabetes managed without insulin
None
Reasons for excluding selected studies cited in previous systematic reviews
None
Results of quality assessment of RCTs using modified Scottish Intercollegiate Guidelines Network-50 checklist for RCTs
None
Results of quality assessment of observational studies using modified Scottish Intercollegiate Guidelines Network-50 checklist for cohort studies
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Comment in

  • Butalia Sonia, Rabi Doreen M. To test or not to test? Self-monitoring of blood glucose in patients with type 2 diabetes managed without insulin. Open Med. 2010;4(2):e114–e116. http://www.openmedicine.ca/article/view/400/330.

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