Effects of Structured Versus Unstructured Self-Monitoring of Blood Glucose on Glucose Control in Patients With Non-insulin-treated Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials - PubMed (original) (raw)

Meta-Analysis

Effects of Structured Versus Unstructured Self-Monitoring of Blood Glucose on Glucose Control in Patients With Non-insulin-treated Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials

Edoardo Mannucci et al. J Diabetes Sci Technol. 2018 Jan.

Abstract

Background: The use of self-monitoring of blood glucose (SMBG) in patients with non-insulin-treated type 2 diabetes is debated. Meta-analyses of randomized clinical trials (RCTs) suggest a small reduction of HbA1c in patients using SMBG, without considering potential confounders, such as SMBG regimen and use of SMBG data to adjust diabetes medications.

Methods: A meta-analysis was performed including RCTs in patients with non-insulin-treated type 2 diabetes, with an intervention of ≥24 weeks and HbA1c as the primary endpoint, to verify the effect of SMBG (vs no monitoring), structured SMBG (vs unstructured), and of SMBG-driven therapy adjustments.

Results: In RCTs (n = 8) comparing SMBG with no SMBG (1277 and 1072 patients, respectively), SMBG reduced HbA1c by -0.17% (95% CI -0.25 to -0.09%, P < .003). The reduction in HbA1c was greater in RCTs (n = 3) in which SMBG data were used to adjust diabetes medications (HbA1c decrease: -0.3% [95% CI -0.49 to -0.1%]) than in RCTs (n = 6) where SMBG data were not used for this purpose (HbA1c decrease: -0.1% [95% CI -0.2 to 0.0%]) ( P < .005). In the RCTs comparing structured and unstructured SMBG (757 and 750 patients, respectively), in which structured SMBG data were also used to adjust diabetes medications, the HbA1c difference between groups at study end was -0.27% (95% CI -0.49 to -0.04%, P < .018).

Conclusions: In RCTs performed in non-insulin-treated patients with type 2 diabetes, SMBG is associated with a significant, although small, reduction in HbA1c. HbA1c reduction was greater with structured SMBG and when structured SMBG data were used to adjust diabetes therapy.

Keywords: meta-analysis; non–insulin treated; self-monitoring of blood glucose; treatment algorithms; type 2 diabetes.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: EM has received speaking fees from Roche Diagnostics, and consulting fees from Abbott and Lifescan. AA has no competing financial interest to disclose. FG has received speaking and consulting fees from Roche Diagnostics. MS has received consulting fees from Roche Diagnostics.

Figures

Figure 1.

Figure 1.

RCT flow diagram.

Figure 2.

Figure 2.

Forest plot of mean HbA1c differences in studies comparing SMBG vs no SMBG (upper panel) or structured SMBG vs unstructured SMBG (lower panel).

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