Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis.
OBJECTIVE
To assess the effect of self-monitoring of blood glucose (SMBG) on glycaemic control in non-insulin treated patients with type 2 diabetes by means of a systematic review and meta-analysis.


METHODS
MEDLINE and the Cochrane Controlled Trials Register were searched from inception to January 2009 for randomised controlled trials comparing SMBG with non-SMBG or more frequent SMBG with less intensive SMBG. Electronic searches were supplemented by manual searching of reference lists and reviews. The comparison of SMBG with non-SMBG was the primary, the comparison of more frequent SMBG with less intensive SMBG the secondary analysis. Stratified analyses were performed to evaluate modifying factors.


METHODS
The primary endpoint was glycated haemoglobin A(1c) (HbA(1c)), secondary outcomes included fasting glucose and the occurrence of hypoglycaemia. Using random effects models a weighted mean difference (WMD) was calculated for HbA(1c) and a risk ratio (RR) was calculated for hypoglycaemia. Due to considerable heterogeneity, no combined estimate was computed for fasting glucose.


RESULTS
Fifteen trials (3270 patients) were included in the analyses. SMBG was associated with a larger reduction in HbA(1c) compared with non-SMBG (WMD -0.31%, 95% confidence interval -0.44 to -0.17). The beneficial effect associated with SMBG was not attenuated over longer follow-up. SMBG significantly increased the probability of detecting a hypoglycaemia (RR 2.10, 1.37 to 3.22). More frequent SMBG did not result in significant changes of HbA(1c) compared with less intensive SMBG (WMD -0.21%, 95% CI -0.57 to 0.15).


CONCLUSIONS
SMBG compared with non-SMBG is associated with a significantly improved glycaemic control in non-insulin treated patients with type 2 diabetes. The added value of more frequent SMBG compared with less intensive SMBG remains uncertain.
Allemann
Sabin
S
University Hospital and University of Bern, Switzerland. allemann@ispm.unibe.ch
Houriet
Carine
C
Diem
Peter
P
Stettler
Christoph
C
D000465:Algorithms; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence
D007004:Hypoglycemic Agents