Self-monitoring of blood glucose in noninsulin-treated type 2 diabetes: an overview

Figures & data

Table 1 Randomized controlled trails of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes not using insulin: patient characteristics

Reference; country	Schwedes 2002; Germany and Austria^Citation9,Citation10	Farmer 2007; UK^Citation11^–^Citation13	Allen 1990; USA^Citation16	Davidson 2005; USA^Citation17	Fontbonne 1989; France^Citation18	Guerci 2003; France^Citation19	Muchmore 1994; USA^Citation20	O’Kane 2008; UK^Citation21	Barnett 2008; Seven countries^Citation14
Previous use of SMBG	No use of SMBG in the last 6 months	No use of SMBG twice a week or more over the previous 3 months	No	?	?	No	No use of SMBG in the last 3 months	No	No current management with SMBG
Male (%)	52	57	100	26	62	55	39	60	52
Age (years)a	~60 (45–70)	65.7 (≥25)	58	~50	~55	~62 (40–75)	~59 (40–75)	~59 (<70)	~56 (40–80)
HbA1c(%)a	~8.4 (7.5–10)	7.5 (≥6.2)	~12.0	~8.5	~8.3	9.0 (7.5–11)	~10.4 (9.5–13.5)	8.7	8.1 (7–10)
Diabetes duration (years)a	~5.3 (≥0.25)	3	~7.9	~5.6	~12.7 (≥3)	~8.0 (≥1)	~5.5 (≥1)	0b	2.8
Body mass index (kg/m^2)a	~31.5 (>25)	~31.3	? (weight: ~93 kg)	32.5	~26.7	~30.1	~34.2 (27.5–44)	~33	~30.4
Treatment	Diet (?%) or diet and oral blood glucose-lowering treatment (?%)	Diet (27%) or diet and oral blood glucose-lowering treatment (73%)	Diet (15%) or diet and oral blood glucose-lowering treatment (85%)	Diet (2%) or diet and oral blood glucose-lowering treatment (98%; 14% triple therapy)	Diet (?%) or diet and oral blood glucose-lowering treatment (?%)	Oral blood glucose-lowering treatment	Diet (26%) or diet and oral blood glucose-lowering treatment (74%)	Newly diagnosed patients	Diet (29%) for ≥3 months or diet and oral blood glucose-lowering treatment (71%)

a Presented data are means or median with between brackets the inclusion range.

b Newly diagnosed patients with type 2 diabetes were included.

Table 2 Randomized controlled trails of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes not using insulin: study characteristics

Study	Duration	Treatment arm		Number of patients
		Intervention	Control	Intervention/Control
Schwedes^Citation9,Citation10	24 weeks	SMBG 6 times a day (pre- and 1 hour postprandial values), 2 days a week (1 week day and Sunday) Documentation of eating habits Documentation of state of well-being Patients were explained that combined information allowed them to make diet and lifestyle changes in order to improve glycemic control counseling to increase self-perception, to promote self-reflection and to enhance self-regulation Therapy adjustment?	Nonstandardized counseling with a focus on diet and lifestyle Therapy adjustment?	113/110
Farmer^Citation11^–^Citation13	12 months	1. Less intensive SMBG 3 times a day (1 fasting and 2 pre- or postprandial values), 2 days a week Strive for preprandial glucose concentrations of 4–6 mmol/l and postprandial 6–8 mmol/L A diary was used to record goals, activities, and blood glucose results No information about how to interpret glucose values was given Therapy adjustment? 2. More intensive In addition to ‘1. less intensive’: Training and support in timing, interpretation and using results also to enhance motivation and maintain adherence to diet, physical activity and drug regimens Encouragement to experiment with SMBG to explore the effects of specific activity Therapy adjustment?	HbA1c every 3 months A diary was used to record self-care goals and strategies for achieving them Usual (standardized) care Information about eating and physical activity Therapy adjustment?	150/151/152
Allen^Citation16	6 months	SMBG before meals every other day, at least 36 times a month Strive for glucose concentrations <7.7 mmol/L fasting and <8.8 mmol/L before lunch and dinner Algorithm to adjust blood glucose-lowering treatment Instructed by dietician about diet, fiber intake, ideal bodyweight, activity level	Urine testing before meals every other day, at least 36 times a month Strive for negative urine checks Algorithm to adjust blood glucose-lowering treatment. Instructed by dietician about diet, fiber intake, ideal body weight, activity level	27/27
Davidson^Citation17	6 months	SMBG before and between 1–2 hours after meals during 6 days a week; 2 times breakfast, 2 times supper and 2 times dinner Record meals 5 visits to dietician; education about meal size and components on rise of postprandial glucose values Strive for glucose concentrations <7.15 mmol/L Algorithm to adjust blood glucose-lowering treatment	Visits to dietician; education about meal size and components on rise of postprandial glucose values Algorithm to adjust blood glucose-lowering treatment	43/45
Fontbonne^Citation18	6 months	SMBG twice every other day; fasting and 2 hours after dinner and on Sundays after lunch Consulting physician was allowed to adjust therapy	1. Urine testing twice every other day; fasting and 2 hours after dinner and on Sundays after lunch Consulting physician was allowed to adjust therapy 2. Every 2 months HbA1c testing with physician’s comment about metabolic control to patient Consulting physician was allowed to adjust therapy	68/72/68
Guerci^Citation19	24 weeks	SMBG at least 6 times a week on 3 different days including a weekend day. Dietary advice about ideal bodyweight. Walking was encouraged as a form of exercise Therapy adjustment?	HbA1c every 12 weeks Dietary advice about ideal body weight Walking was encouraged as a form of exercise Therapy adjustment?	345/344
Muchmore^Citation20	44 weeks	SMBG: first 4 weeks: 6 times daily (pre- and 2 hour postprandial values) Next 16 weeks: 2 times daily (pre- and 2 hour postprandial values). Last 24 weeks: individual choice Strive for a postprandial increase of 2.2–3.9 mmol/L with, if necessary, adjustment of carbohydrate quantity and quality or change in exercise timing or intensity Education about carbohydrate counting Received behavioral weight program (90 min a week during the first 8 weeks). In addition, there were 3 and 4 sessions with a dietician and diabetes nurse, respectively Goal was to lose 0.5–1.0 kg a week Therapy adjustment?	Received general information about nutrition Received behavioral weight program (90 min a week during the first 8 weeks). In addition there were 3 and 4 sessions with a dietician and diabetes nurse, respectively Goal was to lose 0.5–1.0 kg a week Therapy adjustment?	12/11
O’Kane^Citation21	12 months	SMBG 8 times a week; 4 fasting and 4 postprandial values Received advice on interpretation and appropriate (lifestyle) responses to high or low readings Educational program 3-month visits with doctor, diabetes nurse, and dietician Algorithm to adjust blood glucose-lowering treatment	Educational program Every 3 months visits with doctor, diabetes nurse, and dietician Algorithm to adjust blood glucose-lowering treatment	96/88
Barnett^Citation14	27 weeks	SMBG 5 times a day (before each meal, 2 hours after the main meal and before bedtime), 2 days a week (1 working and 1 nonworking day). Once a month postprandial measurements after each meal Diet and lifestyle advice Diary was used to record symptoms of hypoglycemia and actions taken Algorithm to adjust blood glucose-lowering treatment	Diet and lifestyle advice Diary was used to record symptoms of hypoglycemia and actions taken Algorithm to adjust blood glucose-lowering treatment	311/299

Table 3 Randomized controlled trails of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes not using insulin: methodological quality

Criteria	Schwedes^Citation9,Citation10	Farmer^Citation11^–^Citation13	Allen^Citation16	Davidson^Citation17	Fontbone^Citation18	Guerci1^Citation9	Muchmore^Citation20	O’Kane^Citation21	Barnett^Citation14
Randomization adequate	+	+	+	+	+	+	+	+	+
Treatment allocation concealed		+	−					−	+
Groups similar at baseline	+	+	+	+	+	+	+	+	+
Patient blinded	NA	NA	NA	NA	NA	NA	NA	NA	NA
Care provider blinded	NA	NA	NA	NA	NA	NA	NA	NA	NA
Outcome assessor blinded		+/?a						+/?a
Co-interventions avoided	−	+	+	+		+		+	+
Compliance acceptable	+	−	+	−	+		+	−
Withdrawal/drop-out rate acceptable	+	+	+	+	+	−	+	+	+
Timing of outcome assessment similar	+	+	+	+	+	+	+	+	+
Intention to treat analyses	−	+	−	+		+		+
Total quality score	5	(7)8	6	7	5	5	5	(6)7	6
Overall quality conclusion	Low	High	High	High	Low	Low	Low	High	High

a Outcome assessor was only blinded for HbA_1c.

Abbreviation: NA, not applicable.

Table 4 Randomized controlled trails of SMBG in patients with type 2 diabetes not using insulin – study results: HbA_1c

Study	Treatment arm
	Intervention	Control	Intervention vs Control
Schwedes^Citation9,Citation11	8.47 → 7.47	8.35 → 7.81	−0.46 (95% CI −0.77, −0.11)
Farmer^Citation11^–^Citation13	1. 7.41 → 7.28 2. 7.53 → 7.36	7.49 → 7.49	1. − 0.14 (95% CI −0.35, 0.07) 2. −0.17 (95% CI −0.37, 0.03)
Allen^Citation16	12.4 → 10.4	11.7 → 9.7	~0.0 (P > 0.95)
Davidson^Citation17	8.5 → 7.7	8.4 → 7.8	−0.2 (95% CI −1.1, 0.6)
Fontbonne^Citation18	8.2 → ~7.8	1. 8.6 → ~8.5 2. 8.2 → ~7.7	1. ~ −0.2 (NS) 2. ~0.1 (NS)
Guerci^Citation19	9.0 → 8.1	8.9 → 8.4	~ −0.3 (P = 0.009)
Muchmore^Citation20	10.29 → 8.75	10.45 → 9.6	~ −0.7 (NS)
O’Kane^Citation21	8.8 → 6.9	8.6 → 6.9	−0.07 (95% CI −0.38, 0.25)
Barnett^Citation14	8.12 → 6.95	8.12 → 7.20	−0.24 (95% CI −0.45, −0.03)

Table 5 Randomized controlled trails of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes not using insulin – study results: Quality of life and treatment satisfaction

Study 1st author	Questionaire	Treatment arm
		Intervention	Control	Intervention vs Control
Muchmore^Citation20	Diabetes Quality-of-life inventory			NS
Schwedes^Citation9,Citation10	1. Patient well-being questionnaire
	General well-being (total score)			NS
	Subitem ‘Depression’			Reduction in intervention compared to control P = 0.032
	Subitem ‘Lack of well-being’			Reduction in intervention compared to control P = 0.02
	2. Diabetes Treatment Satisfaction Questionnaire (DTSQ)	27.6 → 31.1	27.0 → 30.6	~ −0.1(P = 0.9)
Farmer^Citation11^–^Citation13	1. DTSQ	1. 29.4 → 29.7 2. 29.7 → 30.1	29.3 → 30.0	NS
	2. W-BQ12	1. 24.3 → 24.5 2. 25.2 → 24.9	25.1 → 25.9	NS
	3. EQ-5D	1. 0.781 → 0.755 2. 0.807 → 0.733	0.799 → 0.798	−0.029 (95% CI −0.084, 0.025) −0.072 (95% CI −0.127, −0.017)
O’Kane^Citation21	1. Well-being questionnaire depression (1 of the subitems, other NS)			6.05 (p = 0.011)
	2. DTSQ			NS
	3. Diabetes attitude scale (3 of 7 subscales were included)			NS

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