Meta-analysis: Self-monitoring in non-insulin-treated type 2 diabetes improved HbA 1c by 0.25%
Question Does self-monitoring of blood glucose improve glycemic control in patients with type 2 diabetes who are not treated with insulin? Review scope 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 followup. Primary outcome was HbA 1c level; secondary outcomes were blood pressure and serum cholesterol level. Review methods 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. Main results Meta-analysis of individual patient data showed that self-monitoring blood glucose reduced HbA 1c levels at 3, 6, and 12 months compared with no self-monitoring (Table). Mean pooled reduction in HbA 1c 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 HbA 1c at baseline (P = 0.3), including those with HbA 1c > 64 mmol/mol ( > 8%). Conclusion Self-monitoring of blood glucose in patients with non-insulintreated type 2 diabetes reduces HbA 1c by 0.25% at 6 months compared with no self-monitoring. © 2012 American College of Physicians.