title: Self-monitoring of blood glucose levels in patients with type 2 diabetes mellitus not taking insulin: a meta-analysis.
abstract: OBJECTIVE
  To perform a meta-analysis of randomized controlled trials (RCTs) and systematic reviews evaluating the efficacy of self-monitoring of blood glucose (SMBG) levels among patients with diabetes mellitus (DM).
  
  
  METHODS
  Meta-analysis of RCTs among patients with DM not taking insulin comparing patients with SMBG versus those without SMBG and reporting results as change in glycosylated hemoglobin (A1C) values.
  
  
  METHODS
  Prior systematic reviews and a PubMed search were used to identify studies. Data were extracted by trained physician reviewers working in duplicate. Trials were classified according to duration of the intervention, and random-effects meta-analysis was used to pool results.
  
  
  RESULTS
  Three trials of SMBG of 3 months' duration were too heterogeneous to pool. Nine other trials were identified. Five trials of SMBG of 6 months' duration yielded a pooled effect estimate of a decrease in mean A1C values of -0.21% (95% confidence interval [CI], -0.38% to -0.04%). Four trials that reported outcomes of 1 year or longer yielded a pooled effect estimate of a decrease in mean A1C values of -0.16% (95% CI, -0.38% to 0.05%). Three trials reported hypoglycemic outcomes, which were increased in the patients using SMBG, although this mostly involved asymptomatic or mild episodes.
  
  
  CONCLUSIONS
  At most, SMBG produces a statistically significant but clinically modest effect in controlling blood glucose levels in patients with DM not taking insulin. It is of questionable value in helping meet target values of glucose control.
authors.affiliation: Division of Internal Medicine, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Mailcode PACC, Los Angeles, CA 90073, USA. ali.towfigh@va.gov
authors.forename: Ali
authors.initials: A
authors.lastname: Towfigh
authors.forename: Maria
authors.initials: M
authors.lastname: Romanova
authors.forename: Jane E
authors.initials: JE
authors.lastname: Weinreb
authors.forename: Brett
authors.initials: B
authors.lastname: Munjas
authors.forename: Marika J
authors.initials: MJ
authors.lastname: Suttorp
authors.forename: Annie
authors.initials: A
authors.lastname: Zhou
authors.forename: Paul G
authors.initials: PG
authors.lastname: Shekelle
mesh_terms: D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D006442:Glycated Hemoglobin