Challenging evidence and assumptions: is there a role for self-monitoring of blood glucose in people with type 2 diabetes not using insulin?

Abstract

Background:

There is debate in the literature about the effectiveness of self-monitoring of blood glucose (SMBG) for people with type 2 diabetes (T2DM) who do not use insulin. Several recent systematic reviews and meta-analyses conclude that SMBG does not have any clinical benefit for this group.

Objective:

We critically appraise the available evidence, and argue whether SMBG is warranted for people with non-insulin-treated T2DM.

Results:

Considerable heterogeneity exists amongst the literature, and aspects of the methodology of some of these studies confound interpretation of results. Recent evidence demonstrates that when SMBG is ‘structured’, incorporated as part of a complex intervention, and embedded within education and collaborative care, improvements in average blood glucose levels result. In contrast, studies that do not apply SMBG systematically, or that assess a low frequency SMBG regimen that precludes identification and interpretation of SMBG patterns, are not clinically effective. Psychosocial outcomes, such as self-efficacy and diabetes-related distress, and other clinical outcomes, such as hypoglycaemia detection, should also be considered as important clinical endpoints.

Limitations:

This is not a systematic literature review. The literature is limited by a lack of studies evaluating a ‘structured’ approach to SMBG.

Conclusions:

It is the quality, not quantity, of SMBG that makes a difference to outcomes for people with non-insulin-treated T2DM. The benefits of ‘structured’ SMBG should be considered as part of a complex intervention when making decisions about policy and practice, and assumptions about the benefits of SMBG for people with non-insulin-treated T2DM should be challenged.

Keywords::

• Glucose monitoring
• Self-monitoring of blood glucose
• Structured SMBG
• Type 2 diabetes mellitus

Transparency

Declaration of funding

The authors wrote this manuscript and submitted it for publication without financial assistance, though the per-page publication fee was subsequently supported by Roche Diagnostics Australia through provision of an unrestricted educational grant. Roche Diagnostics Australia was not involved in the preparation of this manuscript.

Declaration of financial/other relationships

J.S. is a member of the Accu-Chek advisory board for Roche Diagnostics Australia, and the ACBRD has received consultancy fees from Roche Diagnostics Australia for her role on this board. The ACBRD has also received consultancy fees from Roche Diagnostics Australia in respect of speaking engagements by J.S. and J.L.B., and to support the development of the STeP IT UP study. The ACBRD has received consultancy fees from Abbott Diabetes Care in relation to J.S.’s speaking engagements and unrestricted educational grants from Medtronic and Sanofi-Aventis. J.F. has received research support from Roche Diagnostics Australia, Medtronic and Sanofi-Aventis.

Acknowledgements

No medical writers or other personnel were involved in the preparation of this manuscript. J.S. and J.L.B. prepared the first draft of the review and, subsequently, worked on revisions with J.F. All authors approve the final version of the manuscript.