Self-monitoring of blood glucose in type 2 diabetes: systematic review

Clar, C; Barnard, K; Cummins, E; Royle, P; Waugh, N

doi:10.3310/hta14120

Cited by 274Diabetes Management and ResearchDiabetes Treatment and ManagementDiabetes Management and Education

Self-monitoring of blood glucose in type 2 diabetes: systematic review

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Clar, C, Barnard, K, Cummins, E, Royle, P, Waugh, N·2010·Health Technology Assessment

DOI 10.3310/hta14120

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Abstract

OBJECTIVES: To examine whether or not self-monitoring of blood glucose (SMBG) is worthwhile, in terms of glycaemic control, hypoglycaemia, quality of life (QoL) and cost per quality-adjusted life-year (QALY), in people with type 2 diabetes (T2DM) who were not treated with insulin or who were on basal insulin in combination with oral agents. DATA SOURCES: Literature searched included systematic reviews published since 1996, and a systematic review and meta-analyses of randomised controlled trials (RCTs) identified from the reviews, and from searches for more recent trials, along with review of qualitative and economic studies. Search strategies were limited to the English language and to articles published since 1996, and included: databases searched from 1996 to April 2009 - The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Web of Science - limited to meeting abstracts; and websites. REVIEW METHODS: The intervention was self-testing of blood glucose with a meter and test strips. Studies included adult patients with T2DM on any oral treatment or combination of regimens, including lifestyle, oral agents or once-daily basal insulin. Existing systematic reviews of SMBG were summarised and results compared. Evidence synthesis of all of the studies meeting the inclusion criteria was carried out using a narrative review. Data were analysed by outcome and subgroups. HbA1c data from RCTs were summarised using a meta-analysis. Heterogeneity was calculated using the chi-squared and I2 methods. The following analyses were carried out: SMBG compared to self-monitoring of urine glucose, SMBG versus no SMBG, more intensive SMBG versus less intensive SMBG, and more intensive SMBG versus no SMBG. Available qualitative data gained from in-depth interview studies, repeated interviews, and questionnaire and survey data were summarised. RESULTS: The review identified 30 RCTs, although few were of high quality. Ten trials comparing SMBG with no SMBG showed statistically significant reduction in HbA1C of 0.21%, which may not be considered clinically significant. A similar, though not statistically significant difference, was shown where SMBG with education was compared to SMBG without education or feedback. RCTs showed no consistent effect on hypoglycaemic episodes and no impact on medication changes. Review of cost-effectiveness studies showed that costs of SMBG per annum vary considerably (10-259 pounds). Although some studies assert that SMBG may lead to savings in health-care costs which may offset the costs of testing, the best analysis to date (DiGEM - Diabetes Glycaemic Education and Monitoring) concluded that SMBG was not cost-effective. Qualitative studies revealed that there was a lack of education in how to interpret and use the data from SMBG, and that failure to act on the results was common. CONCLUSIONS: The evidence suggested that SMBG is of limited clinical effectiveness in improving glycaemic control in people with T2DM on oral agents, or diet alone, and is therefore unlikely to be cost-effective. SMBG may lead to improved glycaemic control only in the context of appropriate education - both for patients and health-care professionals - on how to respond to the data, in terms of lifestyle and treatment adjustment. Also, SMBG may be more effective if patients are able to self-adjust drug treatment. Further research is required on the type of education and feedback that are most helpful, characteristics of patients benefiting most from SMBG, optimal timing and frequency of SMBG, and the circumstances under which SMBG causes anxiety and/or depression.

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A reduction in HbA1c of 0.5% or more is considered clinically significant to reduce the risk of microvascular complications.
“A reduction in HbA1c of 0.5% or more is considered clinically significant to reduce the risk of microvascular complications [30,31].”
From Effectiveness of Digital Medicines to Improve Clinical Outcomes in Patients with Uncontrolled Hypertension and Type 2 Diabetes: Prospective, Open-Label, Cluster-Randomized Pilot Clinical Trial (2017) · cites this paper as [30]
In the Bloss et al study, no instructions were given to providers on use of the device data; this has been shown to make blood glucose monitoring less effective in non-insulin-using diabetes patients.
“In that study, no instructions were given to providers on use of the device data; this has been shown to make blood glucose monitoring less effective in non-insulin-using diabetes patients [30,34].”
From Effectiveness of Digital Medicines to Improve Clinical Outcomes in Patients with Uncontrolled Hypertension and Type 2 Diabetes: Prospective, Open-Label, Cluster-Randomized Pilot Clinical Trial (2017) · cites this paper as [30]
Healthcare professionals do not use SMBG data to guide clinical discussion and treatment recommendations for adults with non-insulin-treated type 2 diabetes.
“healthcare professionals do not use SMBG data to guide clinical discussion and treatment recommendations (70).”
From The impact of structured self-monitoring of blood glucose on clinical, behavioral, and psychosocial outcomes among adults with non-insulin-treated type 2 diabetes: a systematic review and meta-analysis (2023) · cites this paper as [70]
Adults with non-insulin-treated type 2 diabetes lack understanding of how to interpret and respond to SMBG data.
“previous research suggests that adults with non-insulin-treated type 2 diabetes lack understanding of how to interpret and respond to SMBG data”
From The impact of structured self-monitoring of blood glucose on clinical, behavioral, and psychosocial outcomes among adults with non-insulin-treated type 2 diabetes: a systematic review and meta-analysis (2023) · cites this paper as [70]

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Self‐monitoring in Type 2 diabetes: a randomized trial of reimbursement policy
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Self-monitoring of blood glucose in type 2 diabetes: a new look at published trials
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Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial.
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Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin
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Changing Behavior Using the Theory of Planned Behavior
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Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings: A Randomized Trial
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Changing Behavior Using the Health Action Process Approach
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Consensus Report: The Current Role of Self-Monitoring of Blood Glucose in Non-Insulin-Treated Type 2 Diabetes
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Effects of Structured Versus Unstructured Self-Monitoring of Blood Glucose on Glucose Control in Patients With Non-insulin-treated Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials
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Self-Monitoring of Blood Glucose in Diabetes: From Evidence to Clinical Reality in Central and Eastern Europe—Recommendations from the International Central-Eastern European Expert Group
Czupryniak, L., Barkai, L., Bolgarska, S. V., Bronisz, A., Brož, J., Cypryk, K., Honka, M., Janež, A., Krnić, M., Lalic, N. M., et al. (2014) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2013.0302 · Cited by 95 · see citing works
Self-Monitoring of Blood Glucose in Type 2 Diabetes: Recent Studies
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Examining Opportunities for Goal-Directed Self-Tracking to Support Chronic Condition Management
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Mamykina, L., Heitkemper, E., Smaldone, A. M., Kukafka, R., Cole-Lewis, H. J., Davidson, P. G., Mynatt, E. D., Cassells, A. N., Tobin, J. N., & Hripcsak, G. M. (2017) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2017.09.013 · Cited by 79 · see citing works
A single nanowire sensor for intracellular glucose detection
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Examining Self-Tracking by People with Migraine
Schroeder, J., Chung, C.-F., Epstein, D. A., Karkar, R., Parsons, A., Murinova, N., Fogarty, J. A., & Munson, S. A. (2018) · Designing Interactive Systems Conference · doi:10.1145/3196709.3196738 · Cited by 77 · see citing works
A Behavioral Lifestyle Intervention Enhanced With Multiple-Behavior Self-Monitoring Using Mobile and Connected Tools for Underserved Individuals With Type 2 Diabetes and Comorbid Overweight or Obesity: Pilot Comparative Effectiveness Trial
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Habit Interventions
Gardner, B., Rebar, A. L., & Lally, P. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.041 · Cited by 69 · see citing works
Health Economic Evaluation of Type 2 Diabetes Mellitus: A Clinical Practice Focused Review
Liebl, A., Khunti, K. K., Orozco‐Beltrán, D., & Yale, J. (2015) · Clinical Medicine Insights Endocrinology and Diabetes · doi:10.4137/cmed.s20906 · Cited by 67 · see citing works
Self-Monitoring of Blood Glucose in Noninsulin-Using Type 2 Diabetic Patients
Malanda, U. L., Bot, S. D. M., & Nijpels, G. (2012) · Diabetes Care · doi:10.2337/dc12-0831 · Cited by 137 · see citing works
The Effect of a Smartphone-Based, Patient-Centered Diabetes Care System in Patients With Type 2 Diabetes: A Randomized, Controlled Trial for 24 Weeks
Kim, E. K., Kwak, S. H., Jung, H. S., Koo, B. K., Moon, M. K., Lim, S., Jang, H. C., Park, K. S., & Cho, Y. M. (2019) · Diabetes Care · doi:10.2337/dc17-2197 · Cited by 61 · see citing works
Impact of Information Technology on the Therapy of Type-1 Diabetes: A Case Study of Children and Adolescents in Germany
Berndt, R.-D., Takenga, C., Preik, P., Kuehn, S., Berndt, L., Mayer, H., Kaps, A., & Schiel, R. (2014) · Journal of Personalized Medicine · doi:10.3390/jpm4020200 · Cited by 61 · see citing works
Changing Behavior Using Social Cognitive Theory
Łuszczyńska, A., & Schwarzer, R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.003 · Cited by 71 · see citing works
Screening for hyperglycaemia in pregnancy: a rapid update for the National Screening Committee
Waugh, N. R., Royle, P., Clar, C., Henderson, R., Cummins, E., Hadden, D. R., Lindsay, R. S., & Pearson, D. (2010) · Health Technology Assessment · doi:10.3310/hta14450 · Cited by 59 · see citing works
Self-citation
Consensus statement on dose modifications of antidiabetic agents in patients with hepatic impairment
Gangopadhyay, K., & Singh, P. (2017) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_512_16 · Cited by 59 · see citing works
Self-monitoring blood glucose improves glycemic control in type 2 diabetes without intensive treatment: a systematic review and meta-analysis
Machry, R. V., Rados, D. V., Gregório, G. R. D., & Rodrigues, T. C. (2018) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2018.05.037 · Cited by 55 · see citing works
Using technology to support clinical care and research in rheumatoid arthritis
Dixon, W. G., & Michaud, K. D. (2018) · Current Opinion in Rheumatology · doi:10.1097/bor.0000000000000485 · Cited by 56 · see citing works
Psychological trauma symptoms and Type 2 diabetes prevalence, glucose control, and treatment modality among American Indians in the Strong Heart Family Study
Jacob, M. M., Gonzales, K. L., Calhoun, D., Beals, J., Muller, C. J., Goldberg, J. H., Nelson, L. A., Welty, T. K., & Howard, B. V. (2013) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2013.07.008 · Cited by 53 · see citing works
Self-Efficacy Interventions
Warner, L. M., & French, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.032 · Cited by 53 · see citing works
Development of cellulose paper testing strips for quick measurement of glucose using chromogen agent
Cha, R., Wang, D., He, Z., & Ni, Y. (2012) · Carbohydrate Polymers · doi:10.1016/j.carbpol.2012.02.028 · Cited by 50 · see citing works
Changing Behavior Using Ecological Models
Salmon, J., Hesketh, K. D., Arundell, L., Downing, K. L., & Biddle, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.017 · Cited by 51 · see citing works
Economic impact of hypoglycemia on healthcare in Spain
Brito-Sanfiel, M. Á., Diago, J. I., & Calderón, A. (2010) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/erp.10.73 · Cited by 48 · see citing works
Effect of Ambient Temperature on Analytical Performance of Self-Monitoring Blood Glucose Systems
Nerhus, K., Rustad, P., & Sandberg, S. (2011) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2010.0255 · Cited by 46 · see citing works
Self monitoring of blood glucose - a survey of diabetes UK members with type 2 diabetes who use SMBG
Barnard, K. D., Young, A. J., & Waugh, N. R. (2010) · BMC Research Notes · doi:10.1186/1756-0500-3-318 · Cited by 45 · see citing works
Self-citation
Patient perspectives on self-monitoring of blood glucose: perceived recommendations, behaviors and barriers in a clinic sample of adults with type 2 diabetes
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Authors: Clar, C., Barnard, K., Cummins, E., Royle, P., & Waugh, N.
Affiliations: Researcher in Systematic Reviews, Berlin, Germany
ORCID: Cummins, E
Royle, P
Venue: Health Technology Assessment
Publisher: National Institute for Health and Care Research
Published: 2010-03
Volume: 14
Issue: 12
Pages: 1-140
ISSN: 1366-5278 (ISSN-L)
2046-4924
DOI: 10.3310/hta14120
OpenAlex: W1979965121
Cited by: 274
References: 223
Citations by year: 2026: 5 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 6 · 2020: 58 · 2019: 13 · 2018: 20 · 2017: 22 · 2016: 17 · 2015: 20 · 2014: 19 · 2013: 25 · 2012: 20
FWCI: 3.49
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by
www.nationalarchives.gov.uk/doc/non-commercial-government-licence/non-commercial-government-licence.htm (unspecified)
Locations: Health Technology Assessment (publishedVersion, cc-by)
PubMed (publishedVersion)
Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Health Technology Assessment programme (09/19/01)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords: self-monitoring of blood glucose, type 2 diabetes, glycemic control, HbA1c, hypoglycemia, quality of life, cost-effectiveness, basal insulin, oral antidiabetic drugs, patient education, urine glucose testing, health care costs, medication changes, patient empowerment, diabetes self-management education, patient-centered care
MeSH terms: Aged, Diabetes Mellitus, Type 2, Female, United Kingdom, Humans, Male, Middle Aged, Blood Glucose Self-Monitoring

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Self-monitoring of blood glucose in type 2 diabetes: systematic review

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