Self-Monitoring of Blood Glucose in Patients with Type 2 Diabetes Mellitus Who are Not Using Insulin

Summary

A Cochrane review [Abstract] 1 included 12 studies with a total of 3259 patients to assess the effects of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes mellitus who are not using insulin. Nine trials compared SMBG with usual care without monitoring, one study compared SMBG with self-monitoring of urine glucose (SMUG), one study was a three-armed trial comparing SMBG and SMUG with usual care and one study was a three-armed trial comparing less intensive SMBG and more intensive SMBG with a control group. Meta-analysis of studies including patients with a diabetes duration of one year or more showed a significant SMBG-induced decrease in HbA1c at up to 6 months follow-up (-0.3; 95% CI -0.4 to -0.1; n = 2324 participants, 9 trials), yet an overall non-significant SMBG- induced decrease was seen at 12 month follow-up (-0.1; 95% CI -0.3 to 0.04; n = 493 participants, 2 trials). Analysis of the effect of SMBG on well-being and quality of life showed no effect on patient satisfaction, general well-being or general health-related quality of life.

A open-label randomized multicentre trial 2 included 450 patients with type 2 non-insulin-treated diabetes (older than 30 years, established with a primary care physician at a participating practice, had HbA1c levels higher than 6.5% but lower than 9.5% within the 6 months preceding screening). Patiens were randomized to no SMBG, once-daily SMBG, and once-daily SMBG with enhanced patient feedback including automatic tailored messages delivered via the meter. 92.9% completed the final visit. There were no significant differences in hemoglobin A1c levels across all 3 groups (P = .74; estimated adjusted mean hemoglobin A1c difference, SMBG with messaging vs no SMBG, -0.09%; 95% CI -0.31% to 0.14%; SMBG vs no SMBG, -0.05%; 95% CI -0.27% to 0.17%). There were also no significant differences found in health related quality of life. There were no notable differences in key adverse events including hypoglycemia frequency, health care utilization, or insulin initiation.