Systematic Review of Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes

Abstract

The benefit of self-monitoring of blood glucose (SMBG) in the reduction of HbA1c in non-insulintreated participants remains unclear. HbA1c may be improved in this population with SMBG. We aimed to investigate this. Materials and methodsMeta-analyses of randomized controlled trials (RCTs) were performed comparing SMBG versus usual care and structured versus unstructured SMBG; the effect of clinician therapy adjustment based on SMBG readings was examined. Medline, Embase and Cochrane Central were electronically searched to identify articles published from 1 January 2000 to 30 June 2020. Trials investigating changes in HbA1c were selected. Screening was performed independently by two investigators. Two investigators extracted HbA1c at baseline and follow-up for each trial. ResultsNineteen RCTs, involving 4,965 participants were included. Overall, SMBG reduced HbA1c. Preplanned subgroup analysis showed that using SMBG readings to adjust therapy contributed significantly to the reduction. No significant improvement in HbA1c was shown in SMBG without therapy adjustment). The same difference was observed in structured SMBG compared to unstructured SMBG. ConclusionsHbA1c is improved with therapy adjustment based on structured SMBG readings. Implications are for clinicians to prescribe structured SMBG with an aim for therapy adjustment based on the readings, and not prescribing unstructured SMBG. Participants with suboptimal glycemic control may benefit most. A SMBG regimen that improves clinical-and cost-effectiveness is presented. Future studies can investigate this regimen specifically.

The impact of structured self-monitoring of blood glucose on clinical, behavioral, and psychosocial outcomes among adults with non-insulin-treated type 2 diabetes: a systematic review and meta-analysis

“…The latter is consistent with the findings of two prior metaanalyses, which identified greater clinical benefit when SMBG was followed by responsive treatment modifications (29,30). However, this was not observed in the current study likely due to the broader inclusion criteria.…”

“…when HbA1c is above target or treatment modification is required ( 15 , 25 ),. Such targeted use of sSMBG may be both clinically- and cost-effective ( 21 , 29 , 30 ).…”

“…Recent meta-analyses ( 29 , 30 ) have examined the clinical efficacy of sSMBG compared to uSMBG, among adults with non-insulin-treated type 2 diabetes. They identified greater improvement in HbA1c associated with sSMBG ( 29 , 30 ), particularly when monitoring data informed medication adjustments ( 29 ).…”

COVID-19 Outcomes Stratified by Control Status of Hypertension and Diabetes: Preliminary Findings From PCORnet, U.S.

“…14 Public health messaging for patients and providers can encourage routine care, use of telehealth, and strategies such as self-measured blood pressure monitoring and home blood glucose measurements with clinical support. 15,16 Future work can examine whether chronic disease control status is associated with COVID-19 outcomes.…”

Frequency of Follow-Up Attendance and Blood Glucose Monitoring in Type 2 Diabetic Patients at Moderate to High Cardiovascular Risk: A Cross-Sectional Study in Primary Care

“…The results of blood glucose monitoring are important information for physicians to provide appropriate treatment regimens with tailored lifestyle advice to achieve glycaemic control and prevent disease progression [ 5 , 6 , 7 ]. A large body of evidence has accumulated over the years documenting that regular follow-up care [ 8 , 9 ] and structured monitoring of blood glucose [ 10 , 11 ] could significantly prevent the deterioration in glycaemic status. However, previous investigations showed that more than two-fifth of patients with T2DM failed to achieve follow-up attendance at least once per quarter at community health centres [ 12 ], and that only less than one-fifth of T2DM patients were able to perform blood glucose monitoring on a regular basis [ 13 ].…”