Systematic Review of Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes

Background: The benefit of self-monitoring of blood glucose in reducing HbA(1c) in non-insulin-treated participants remains unclear. HbA(1c) may be improved in this population with said self-monitoring. Objective: The aim of this study was to conduct meta-analyses of glycemic control in non-insulin-treated participants with Type 2 diabetes: self-monitoring of blood glucose versus usual care, structured versus unstructured self-monitoring of blood glucose, and use of self-monitoring of blood glucose readings by clinicians to adjust (or modify) therapy versus usual care. Methods: MEDLINE, Embase, and Cochrane Central were electronically searched to identify articles published from January 1, 2000, to June 30, 2020. Trials investigating changes in HbA(1c) were selected. Screening was performed independently by two investigators. Two investigators extracted HbA(1c) at baseline and follow-up for each trial. Results: Nineteen trials involving 4,965 participants were included. Overall, self-monitoring of blood glucose reduced HbA(1c). Preplanned subgroup analysis showed that using self-monitoring of blood glucose readings to adjust therapy contributed significantly to the reduction. No significant improvement in HbA(1c) was shown in self-monitoring of blood glucose without therapy adjustment. The same difference was observed in structured versus unstructured self-monitoring of blood glucose. Discussion: HbA(1c) is improved with clinician therapy modification based on structured self-monitoring of blood glucose readings. Implications are for clinicians to prescribe structured self-monitoring of blood glucose to modify therapy based on the readings and not prescribe unstructured self-monitoring of blood glucose. Participants with suboptimal glycemic control may benefit most. A self-monitoring of blood glucose regimen that improves clinical and cost-effectiveness is presented. Future studies can investigate this regimen specifically.