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Self-monitoring blood glucose improves glycemic control in type 2 diabetes without intensive treatment: A systematic review and meta-analysis

  • Rafael Vaz Machry
    Correspondence
    Corresponding author at: Endocrinology Division, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350 Prédio 12, 4° andar, CEP 90035-003 Porto Alegre, Brazil.
    Affiliations
    Post Graduate Program in Medical Sciences – Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil

    Department of Internal Medicine, Medical School, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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  • Dimitris Varvaki Rados
    Affiliations
    Post Graduate Program in Medical Sciences – Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil

    Division of Internal Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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  • Guilherme Ribeiro de Gregório
    Affiliations
    Medical School, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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  • Ticiana Costa Rodrigues
    Affiliations
    Post Graduate Program in Medical Sciences – Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil

    Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Department of Internal Medicine, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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      Highlights

      • Systematic review and meta-analysis to evaluate the Self-Monitoring of Blood Glucose (SMBG).
      • We randomized controlled trials conducted in patients with T2D comparing SMBG to a control group.
      • SMBG was associated with reduced HbA1c at 12 and 24 weeks, but no difference was found for 1-year.
      • Studies with HbA1c at baseline greater than HbA1c 8% showed a higher benefit in 12 and 24 weeks.

      Abstract

      Aims

      Systematic review and meta-analysis to evaluate the effect of Self-Monitoring of Blood Glucose (SMBG) on glycemic control in patients with type 2 Diabetes (T2D).

      Methods

      We searched the Medline, Embase, Cochrane Central, and ClinicalTrials.gov databases up to 20 July 2017. We also performed a manual search of abstracts from recent meetings of the American Diabetes Association and the European Association for the Study of Diabetes. Study selection: randomized controlled trials (RCTs) conducted in patients with T2D comparing any kind of SMBG to a control group. Two independent reviewers assessed the eligibility of references. Influence of SMBG in glycated hemoglobin (HbA1c) was aggregated as weighted mean difference accessed by direct random effect meta-analyses at 12, 24 weeks and 1 year. Sub-analyses were made to assess the effects of previous glycemic control and number of tests performed.

      Results

      SMBG was associated with a reduction of HbA1c at 12 weeks (−0.31%; 95% CI: −0.57 to −0.05) and 24 weeks (−0.34%; 95%CI: −0.52 to −0.17), but no difference was found for 1 year. Subgroup analysis including studies with baseline HbA1c greater than 8% showed a higher reduction of HbA1c: −0.83% (95% CI: −1.55 to −0.11) at 12 weeks, and −0.48% (95% CI: −0.77 to −0.19) at 24 weeks, with no difference for 1 year nor for the stratification for number the tests.

      Conclusion

      SMBG seems to lead to a slightly better glycemic control in the short term in patients with T2D. Patients decompensated at baseline appear to have the greatest benefit. PROSPERO register: CRD42016033558.

      Keywords

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