Laura Rees Willett, MD, FACP
Does self-monitoring of blood glucose improve glycemic control in patients with type 2 diabetes who are not treated with insulin?
Included studies compared self-monitoring of blood glucose with no self-monitoring in patients with non–insulin-treated type 2 diabetes, included ≥ 80 patients, and had ≥ 6 months of follow-up. Primary outcome was HbA1c level; secondary outcomes were blood pressure and serum cholesterol level.
MEDLINE and EMBASE/Excerpta Medica (Apr 2009 to Jun 2010), the reference list of a systematic review that included studies from January 2000 to April 2009, reference lists of other reviews, conference proceedings, and a current controlled trials register were searched for randomized controlled trials (RCTs). Authors of included studies were contacted for individual patient data. 6 RCTs (n = 2552, mean age 60 y, 54% men) met inclusion criteria. 3 RCTs described randomization, and all had allocation concealment and blinded outcome assessors. Loss to follow-up ranged from 2% to 31% (mean 15%). Analysis was by intention-to-treat.
Meta-analysis of individual patient data showed that self-monitoring blood glucose reduced HbA1c levels at 3, 6, and 12 months compared with no self-monitoring (Table). Mean pooled reduction in HbA1c was 9.6 mmol/mol (0.88%) in the intervention group and 7.5 mmol/mol (0.69%) in the usual care group. Groups did not differ for blood pressure or total cholesterol (Table). Results were similar across patients with different levels of HbA1c at baseline (P = 0.3), including those with HbA1c > 64 mmol/mol (> 8%).
Self-monitoring of blood glucose in patients with non–insulin-treated type 2 diabetes reduces HbA1c by 0.25% at 6 months compared with no self-monitoring.
Self-monitoring of blood glucose levels vs no self-monitoring in patients with non–insulin-treated type 2 diabetes*
*Abbreviations defined in Glossary.
†Adjusted for baseline measures, age, sex, and duration of diabetes using a random-effects model.
‡Includes average of measurements at 2 and 4 mo for 2 trials. Hazard ratios < 1 favor drug use.
§Combination of measurements at 6 mo and 12 mo.
Willett LR. Meta-analysis: Self-monitoring in non–insulin-treated type 2 diabetes improved HbA1c by 0.25%. Ann Intern Med. ;156:JC6–12. doi: 10.7326/0003-4819-156-12-201206190-02012
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Published: Ann Intern Med. 2012;156(12):JC6-12.
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