非胰岛素治疗 2 型糖尿病患者自我血糖监测的疗效和频率：系统评价和荟萃分析。
The Efficacy and Frequency of Self-monitoring of Blood Glucose in Non-insulin-Treated T2D Patients: a Systematic Review and Meta-analysis.
机构信息
Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
出版信息
J Gen Intern Med. 2023 Feb;38(3):755-764. doi: 10.1007/s11606-022-07864-z. Epub 2022 Nov 20.
BACKGROUND
Self-monitoring of blood glucose (SMBG) is a useful tool in diabetes management, but its efficacy and optimal application in type 2 diabetes (T2D) patients treated without insulin have been controversial. We aimed to evaluate the efficacy of SMBG in controlling blood glucose levels in non-insulin-treated T2D patients and to determine the optimal frequency and the most appropriate population to benefit from SMBG.
METHODS
Eligible publications from January 2000 to April 2022 were retrieved from PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. Randomized controlled trials comparing SMBG with no SMBG or structured SMBG (S-SMBG, SMBG with defined timing and frequency of glucose measurements) were included. Meta-analyses and sub-analyses were performed to assess the efficacy, optimal frequency, and most appropriate population for SMBG. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases.
RESULTS
Twenty-two studies involving 6204 participants were identified, including 17 comparing SMBG with no SMBG and 4 comparing SMBG with S-SMBG. SMBG reduced HbA1c (MD -0.30%, 95% CI -0.42 to -0.17) compared with no SMBG, and S-SMBG performed better than SMBG (MD -0.23%, 95% CI -0.38 to -0.07). Subgroup analyses showed that HbA1c control was better with SMBG at 8-11 times weekly (MD -0.35%, 95% CI -0.51 to -0.20) compared with other frequencies and with lifestyle adjustments (MD -0.37%, 95% CI -0.50 to -0.23) than with no adjustments. No significant differences in HbA1c were observed between baseline HbA1c subgroups (≤ 8% and > 8%, P = 0.63) and between diabetes duration subgroups (≤ 6 years and > 6 years, P = 0.72), respectively.
DISCUSSION
SMBG was effective for controlling HbA1c in non-insulin-treated T2D patients, although lacking detailed monitoring design. Better outcomes were seen with SMBG at 8-11 times weekly and lifestyle adjustment based on SMBG results.
TRIAL REGISTRATION
PROSPERO (CRD42021285604).
背景
自我血糖监测（SMBG）是糖尿病管理中有用的工具，但在未接受胰岛素治疗的 2 型糖尿病（T2D）患者中的疗效及其最佳应用一直存在争议。我们旨在评估 SMBG 在控制非胰岛素治疗的 T2D 患者血糖水平方面的疗效，并确定获益于 SMBG 的最佳频率和最合适的人群。
方法
从 2000 年 1 月至 2022 年 4 月，从 PubMed、Embase、Cochrane 图书馆和 ClinicalTrials.gov 数据库中检索到符合条件的出版物。纳入了比较 SMBG 与无 SMBG 或结构化 SMBG（S-SMBG，有定义时间和血糖测量频率的 SMBG）的随机对照试验。进行了荟萃分析和亚组分析，以评估 SMBG 的疗效、最佳频率和最合适的人群。关于随机化、分配序列隐藏、盲法、结局数据不完整、选择性结局报告和其他偏倚，评估了风险偏倚。
结果
共纳入了 22 项研究，涉及 6204 名参与者，其中 17 项比较了 SMBG 与无 SMBG，4 项比较了 SMBG 与 S-SMBG。与无 SMBG 相比，SMBG 降低了糖化血红蛋白（HbA1c）（MD -0.30%，95%CI -0.42 至 -0.17），S-SMBG 优于 SMBG（MD -0.23%，95%CI -0.38 至 -0.07）。亚组分析显示，与其他频率和无调整相比，SMBG 每周 8-11 次（MD -0.35%，95%CI -0.51 至 -0.20）HbA1c 控制更好，基于 SMBG 结果进行生活方式调整（MD -0.37%，95%CI -0.50 至 -0.23）。在基线 HbA1c 亚组（≤8%和>8%，P=0.63）和糖尿病病程亚组（≤6 年和>6 年，P=0.72）之间，HbA1c 无显著差异。
讨论
SMBG 对控制非胰岛素治疗的 T2D 患者的 HbA1c 有效，但缺乏详细的监测设计。基于 SMBG 结果进行 8-11 次/周的 SMBG 和生活方式调整，效果更好。
试验注册
PROSPERO（CRD42021285604）。
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