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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis

S Allemann, C Houriet, P Diem, and C Stettler.

Review published: 2009.

Link to full article: [Journal publisher]

CRD summary

The review concluded that in non insulin-treated patients with type 2 diabetes, self-monitoring of blood glucose was associated with a significant reduction of HbA1c. Despite some review limitations, the authors' conclusions reflect the data presented and appear likely to be reliable.

Authors' objectives

To assess the effect of self-monitoring of blood glucose on glycaemic control in non-insulin treated patients with type 2 diabetes.

Searching

MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to January 2009, without language restrictions. Search terms were diabetes mellitus, type 2 and blood glucose self-monitoring. Reference lists of relevant papers were searched.

Study selection

Randomised controlled trials (RCTs) were eligible if they compared treatments that incorporated self-monitoring of blood glucose against treatments without (or with less frequent) self-monitoring in non insulin-treated patients with type 2 diabetes. Studies had to report the primary outcome of glycated haemoglobin (HbA1c).

The proportion of females in the included studies ranged from 38% to 74%. Mean age ranged from 50 to 67 years. Mean diabetes duration ranged from zero to 12.5 years. Mean baseline HbA1c ranged from 6.2% to 11.9%. Most interventions also incorporated education, and most comparator treatments comprised of education or usual care. Most studies were conducted in Europe and North America.

Two reviewers independently assessed studies for inclusion. Disagreements were resolved by a third reviewer.

Assessment of study quality

Study quality was evaluated by assessing criteria of allocation concealment, blinding of caregivers and outcome assessors and use of intention-to-treat (ITT) analysis.

The authors did not state how many reviewers performed the quality assessment.

Data extraction

Change from baseline data (with standard deviations) were extracted to calculate mean differences and 95% confidence intervals (CI) in HbA1c between groups. For hypoglycaemia, data were extracted to calculate risk ratios (RRs).

Two reviewers independently extracted data. Disagreements were resolved by a third reviewer.

Methods of synthesis

Meta-analyses were used to pool studies using a fixed-effect model or (when heterogeneity of I2>25% was found) a random-effects model. Heterogeneity was assessed using the I2 statistic. Analyses compared self-monitoring with no monitoring and more frequent monitoring with less frequent monitoring. Funnel plots were used to assess publication bias. Various sensitivity analyses were pre-specified.

Results of the review

Fifteen RCTs (n=3,270 participants, range 23 to 689) were included.

Self-monitoring was associated with significantly lower HbA1c than no monitoring (WMD -0.31%, 95% CI -0.44 to -0.17, I2=33%; 12 RCTs). There was little evidence of publication bias. Sensitivity analyses yielded no statistically significant differences between parameters. Self-monitoring significantly increased the chance of detecting hypoglycaemia (RR 2.10, 95% CI 1.37 to 3.22, I2=59%; six RCTs).

There was no significant difference in HbA1c between the groups for frequent versus less frequent self monitoring (four RCTs, I2=79%).

Authors' conclusions

In non insulin-treated patients with type 2 diabetes, self-monitoring of blood glucose was associated with a significant reduction of HbA1c and a significant improvement in glycaemic control.

CRD commentary

The review addressed a clear question supported by appropriate inclusion criteria. Only two databases were searched for included studies, so some relevant data may have been missed. There were no language restrictions. Suitable methods (such as independent duplicate processes) were used to minimise the risk of reviewer error and bias when selecting studies and extracting data; quality assessment process details were not stated. Study quality was adequately assessed and the results were used as part of the sensitivity analyses. Appropriate methods were used to pool data and assess heterogeneity, although it should be noted that the analyses were based on changes from baseline and not end of treatment values.

The review had some limitations, but the authors' conclusions reflect the data presented and appear likely to be reliable.

Implications of the review for practice and research

The authors did not state any implications for practice.

Research: The authors stated that further studies needed to determine the optimised frequency of glucose measurement.

Funding

Swiss Diabetes Association; Swiss Diabetes Foundation; Swiss National Science Foundation.

Bibliographic details

Allemann S, Houriet C, Diem P, Stettler C. Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis. Current Medical Research and Opinion 2009; 25(12): 2903-2913. [PubMed: 19827909]

Indexing Status

Subject indexing assigned by NLM

MeSH

Algorithms; Blood Glucose Self-Monitoring; Diabetes Mellitus, Type 2 /blood /drug therapy /epidemiology; Humans; Hypoglycemia /epidemiology; Hypoglycemic Agents /adverse effects /therapeutic use; Incidence

AccessionNumber

12010000837

Database entry date

15/06/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 19827909

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