McIntosh Brendan, Yu Changhua, Lal Avtar, Chelak Kristen, Cameron Chris, Singh Sumeet R, Dahl Marshall
Open Med. 2010;4(2):e102-13. Epub 2010 May 18.
Self-monitoring of blood glucose levels is commonly performed by patients with diabetes mellitus. However, there is debate surrounding the clinical utility and cost-effectiveness of this practice among patients with type 2 diabetes managed without insulin. We conducted a systematic review and meta-analysis to determine the effect of self-monitoring versus no self-monitoring, and the optimal frequency of self-monitoring, in this population.
MEDLINE, EMBASE, BIOSIS Previews, CINAHL and PsycINFO were searched for randomized controlled trials (RCTs) and observational studies published in English from January 1990 to March 2009. Additional citations were obtained through searches of the Internet and conference proceedings, and from stakeholder feedback. Two reviewers independently selected studies, extracted data and performed an assessment of the methodologic quality of the studies. Key outcomes of interest were hemoglobin A1c (HbA(₁c)) concentration, hypoglycemia, quality of life, long-term complications of diabetes and death. Where appropriate, we pooled data using random-effects meta-analysis.
We identified 1624 citations through the literature search and selected 25 articles for inclusion. We observed a statistically significant improvement in the HbA(₁c) concentration across RCTs that compared self-monitoring of blood glucose levels with no self-monitoring among patients taking oral antidiabetes drug therapy (weighted mean difference --0.25%, 95% confidence interval -0.36% to -0.15%). Subgroup analysis indicated that results from RCTs that provided patients with education on how to interpret and apply self-monitoring test results were similar to those from RCTs that did not. On the basis of limited evidence, self-monitoring of blood glucose levels did not demonstrate consistent benefits in terms of quality of life, patient satisfaction, prevention of hypoglycemia or long-term complications of diabetes, or reduction of mortality. There was insufficient evidence pertaining to the optimal frequency of self-monitoring.
Self-monitoring of blood glucose levels was associated with a modest, statistically significant reduction in hemoglobin A1c concentrations, regardless of whether patients were provided with education on how to interpret and use the test results. Further studies are required to determine whether self-monitoring reduces the risk of long-term complications of diabetes and to identify patients most likely to benefit from self-monitoring.
糖尿病患者通常会进行血糖水平的自我监测。然而，对于非胰岛素治疗的2型糖尿病患者，这种做法的临床实用性和成本效益存在争议。我们进行了一项系统评价和荟萃分析，以确定在该人群中自我监测与不进行自我监测的效果，以及自我监测的最佳频率。
检索MEDLINE、EMBASE、BIOSIS Previews、CINAHL和PsycINFO数据库，查找1990年1月至2009年3月以英文发表的随机对照试验（RCT）和观察性研究。通过互联网搜索、会议论文集以及利益相关者反馈获取其他参考文献。两名评价员独立选择研究、提取数据并对研究的方法学质量进行评估。感兴趣的主要结局包括糖化血红蛋白（HbA₁c）浓度、低血糖、生活质量、糖尿病长期并发症和死亡。在适当情况下，我们使用随机效应荟萃分析合并数据。
通过文献检索共识别出1624条参考文献，选择25篇文章纳入研究。在口服抗糖尿病药物治疗的患者中，比较血糖自我监测与不进行自我监测的RCT显示，HbA₁c浓度有统计学意义的显著改善（加权平均差-0.25%，95%置信区间-0.36%至-0.15%）。亚组分析表明，为患者提供如何解读和应用自我监测测试结果教育的RCT结果与未提供此类教育的RCT结果相似。基于有限的证据，血糖自我监测在生活质量、患者满意度、预防低血糖或糖尿病长期并发症以及降低死亡率方面未显示出一致的益处。关于自我监测的最佳频率，证据不足。
血糖自我监测与糖化血红蛋白浓度适度、有统计学意义的降低相关，无论患者是否接受了如何解读和使用测试结果的教育。需要进一步研究以确定自我监测是否能降低糖尿病长期并发症的风险，并确定最可能从自我监测中获益的患者。
