Self-monitoring in Type 2 diabetes mellitus: a meta-analysis

Aims Self-monitoring of blood or urine glucose is widely used by subjects w ith Type 2 diabetes mellitus. This study evaluated the effectiveness of the technique at improving blood glucose control through a systematic review a nd meta-analysis. Methods Randomized controlled trials were identified that compared the effe cts of blood or urine glucose monitoring with no self-monitoring, or blood glucose self-monitoring with urine glucose self-monitoring, on glycated hae moglobin as primary outcome in Type 2 diabetes. Results Eight reports were identified. These were rated for quality and dat a were abstracted. The mean (sd) quality score was 15.0 (1.69) on a scale r anging from 0 to 28. No study had sufficient power to detect differences in glycated haemoglobin (GHb) of less than 0.5%. One study was excluded becau se it was a cluster randomized trial of a complex intervention and one beca use fructosamine was used as the outcome measure. A meta-analysis was perfo rmed using data from four studies that compared blood or urine monitoring w ith no regular monitoring. The estimated reduction in GHb from monitoring w as -0.25% (95% confidence interval -0.61 to 0.10%). Three studies that comp ared blood glucose monitoring with urine glucose monitoring were also combi ned. The estimated reduction in GHb from monitoring blood glucose rather th an urine glucose was -0.03% (-0.52 to 0.47%). Conclusions The results do not provide evidence for clinical effectiveness of an item of care with appreciable costs. Further work is needed to evalua te self-monitoring so that resources for diabetes care can be used more eff iciently.