Self monitoring of blood glucose may reduce HbA1c in type 2 diabetes not on insulin

Self testing of blood glucose

An updated Cochrane systematic review found inconsistent evidence of benefit for self-monitoring of blood glucose (SMBG) in people with type 2 diabetes who do not use insulin.

Clinical question:

In type 2 diabetes not on insulin, does SMBG, as compared with usual care, reduce HbA1c?

The reviewers also looked at adverse events (including hypoglycemia), quality of life and cost outcomes.

The evidence:

The review included 12 studies, comprising 3,259 patients.  The reviewers found that for most of the analyses they planned, there was insufficient or inconsistent data.

However, they did find some statistically significant evidence of benefit for SMBG in:

  1. newly-diagnosed patients at 12 months of follow-up,
  2. patients with a duration of more than a year, a 6 months of follow-up,
  3. greater detection of asymptomatic hypoglycaemia

Appraisal hints

Users of this research should consider:

  • The large amount of important heterogeneity between the studies.  Different studies use different definitions of SMBG, with different target populations and differently defined outcomes.  You may be better to seek out a good quality individual trial that is more directly relevant to your patient and setting.
  • The inconsistency between analyses undertaken at 6 months and 12 months of follow-up.
  • Is the reported benefit clinically important?
  • Any testing regime can only have benefit if it is accompanied by appropriate changes in treatment.

Reference

The full text of this review is available at:

Malanda UL, Welschen LMC, Riphagen II, Dekker JM, Nijpels G, Bot SDM. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD005060. DOI: 10.1002/14651858.CD005060.pub3.

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Badenoch

Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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