Systematic review on self-monitoring of blood glucose for non-insulin-using type 2 diabetes patients

Abstract

The increasing prevalence causes great burden to global health. Although there is not yet an agreement on the effect of SMBG for non-insulin-treating type 2 DM patients in comprehensive management, some guidelines recommended all diabetes patients should conduct SMBG. This literature review of 5 meta-analyses and 13 randomized controlled clinical trials assessed the effectiveness of SMBG in glucose control (HbA1c), detection of hypoglycemia, non-glycemic outcomes and potential influence factors(duration of diabetes, baseline HaB1c level, SMBG frequency, SMBG duration, co-interventions) of SMBG efficacy on type 2 diabetes patients not using insulin. The method of this literature review is through a comprehensive electronic literature search of Ovid MEDLINE, EMBASE, the Cochrane Library and China Journals Full-text Database. Both English and Chinese language literatures were reviewed. All meta-analysis and randomized controlled trials of type 2 diabetes non-insulin-using patients taking SMBG to improve the glycemic control and other outcomes were included. In these studies, absolute HbA1c reduction, recognized episodes of hypoglycemia, wellbeing, QALY, DALY, complication morbidity, mortality were used as outcome measures if available. A score list based on the PRISMA Statement was used to evaluate the quality of meta-analyses. 5 meta-analysis all reported a statistical significant but clinical modest-moderate difference in HbA1c reduction between SMBG and non-SMBG group, a new published randomized controlled trial with small cohort enrolled in none of the meta- analyses did not support this conclusion. Evidence showed frequency of SMBG did not influence the efficacy of SMBG, co-interventions as education/consultation, regimen change played a positive roll on SMBG efficacy. Whether baseline HbA1c, duration of diabetes or SMBG itself have an effect on SMBG efficacy was still unknown. There is inadequate evidence of SMBG efficacy of detection of hypoglycemia of patient-oriented outcomes. No eligible Chinese article was defined to enroll in this review. This review did not support to suggest all type 2 diabetes patients not using insulin to conduct SMBG at the frequency the guidelines recommended. Carefully designed and longer-term trials are needed to obtain evidence that is more robust. Further investigation would provide more evidence of the characteristics of potential influence factors, which may help to define the specific population or optimal mode that guarantee the greatest efficacy of SMBG.