Posted Feb 13 , 2018 01:41 AM

Effects of Structured Versus Unstructured Self-Monitoring of Blood Glucose on Glucose Control in Patients with Non-insulin-treated Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials

Mannucci E, et al. Journal of Diabetes Science and Technology 2018;12:183-189

What were the findings (excerpted from the Abstract)?

The use of self-monitoring of blood glucose (SMBG) in people with non-insulin-treated type 2 diabetes is debated. Meta-analyses of randomized clinical trials (RCTs) suggest a small reduction of A1C in patients using SMBG, without considering potential confounders, such as SMBG regimen and use of SMBG data to adjust diabetes medications and other factors. The authors performed a meta-analysis including RCTs in patients with non-insulin-treated type 2 diabetes, with an intervention of ≥24 weeks and A1C as the primary endpoint, to verify the effect of SMBG (vs no monitoring), structured SMBG (vs unstructured), and of SMBG-driven therapy adjustments. In RCTs (n = 8) comparing SMBG with no SMBG (1277 and 1072 patients, respectively), SMBG significantly reduced A1C by –0.17%. The reduction in A1C was greater in RCTs (n = 3) in which SMBG data were used to adjust diabetes medications (HbA1c decrease: –0.3%, than in RCTs (n = 6) where SMBG data were not used for this purpose (HbA1c decrease: –0.1%. In the RCTs comparing structured and unstructured SMBG (757 and 750 patients, respectively), in which structured SMBG data were also used to adjust diabetes medications, the HbA1c difference between groups at study end was –0.27%.

Why is this important?

In RCTs performed in non-insulin-treated patients with type 2 diabetes, SMBG is associated with a significant, although small, reduction in A1C. A1C reduction was greater with structured SMBG and when structured SMBG data were used to adjust diabetes therapy. There are many articles in the literature that support structured testing. The issue of the value of SMBG actually hinges on USING the results of SMBG testing to empower patients to make good choices related to diet and exercise and inform their healthcare provider to make important medication decisions. Despite the evidence from studies such as the one by Polonsky (Diabetes Care 34:262–267, 2011), single tests in the morning tend to be the common SMBG practice. Multiple tests surrounding different meals are a great way to change data (SMBG numbers) into information (e.g., how the numbers changed based on the breakfast you ate). It is the USE of SMBG information that makes the tool valuable. Working with each patient who performs single SMBG testing before breakfast (usually the lowest number they will be all day) to an empowered patient who has information to make better choices for meals is well worth the effort. Do you recommend structured SMBG testing? Will you now?

Read the Abstract: