Home glucose monitoring makes little difference in type 2 diabetes.
Welschen LM, Bloemendal E, Nijpels G, Dekker JM, Heine RJ, Stalman WA, Bouter LM. Self-monitoring of blood glucose in patients with type 2 diabetes who are not using insulin. Diabetes Care 2005; 28:1510-1517.
* Clinical Question
In patients with type 2 diabetes who are not using insulin, does home monitoring of blood glucose improve care?
Meta-analysis (randomized controlled trials)
The researchers conducting this meta-analysis started by searching 3 databases for randomized controlled studies evaluating blood glucose self-monitoring with typical care in patients with type 2 diabetes who were not using insulin. They also searched the reference lists of identified studies for other studies. They did not attempt to find unpublished studies, research that's usually rejected because it doesn't find a difference.
Two authors independently reviewed the studies for inclusion and evaluated the methodologic quality, and 2 authors independently extracted the data. The study quality was moderate for 4 of the studies and high for 2 of them. However, patients in the 6 studies included in this analysis were not blinded.
Concealed allocation was either not done or not described in any of the studies, allowing the very real possibility that the patients in the blood glucose monitoring groups were different from those in the control groups. They were also highly motivated patients; patients doing the self-monitoring checked blood glucose levels from twice every other day to 6 times per day, 6 days per week. The comparison groups in the study either did no self-monitoring or monitored urine glucose.
In the 5 studies that compared blood glucose monitoring with no monitoring, Hb Alc levels were nominally but significantly lower in the blood glucose monitoring group (-0.39%; 95% confidence interval [CI], -0.56 to -0.21) after approximately 6 months of follow-up. Blood glucose monitoring did not produce better Hb Air levels than urine glucose monitoring. Fasting blood glucose levels were not different in the 2 studies that evaluated it, and quality of life was not different with blood glucose monitoring in the 2 studies that evaluated it. In one study of more than 700 patients in which it was monitored, no serious hypoglycemic episodes occurred in any patient.
* Bottom Line
Intensive monitoring of blood glucose in patients with type 2 diabetes not using insulin results in a small decrease in glycosylated hemoglobin (Hb [A.sub.1c]) levels but does not change fasting blood glucose levels. Urine glucose monitoring works just as well. More casual monitoring of blood glucose, such as once a day, has not been studied.
There is a strong possibility that the weak study design was largely responsible for the difference seen in the study. Blood glucose monitoring is expensive: at the intense level of monitoring used in some of these studies (6 times a day), the cost of the monitoring strips alone can be $2000 US per year. (LOE = 1a)
Quality of life was not different with blood glucose monitoring in the 2 studies that evaluated it
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|Title Annotation:||Patient Oriented Evidence that Matters|
|Publication:||Journal of Family Practice|
|Date:||Nov 1, 2005|
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