Holmes-Truscott Elizabeth, Baptista Shaira, Ling Mathew, Collins Eileen, Ekinci EIif I, Furler John, Hagger Virginia, Manski-Nankervis Jo-Anne, Wells Caroline, Speight Jane
School of Psychology, Deakin University, Geelong, VIC, Australia.
The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
Front Clin Diabetes Healthc. 2023 Apr 20;4:1177030. doi: 10.3389/fcdhc.2023.1177030. eCollection 2023.
Self-monitoring of blood glucose (SMBG) is considered of little clinical benefit for adults with non-insulin-treated type 2 diabetes, but no comprehensive review of a structured approach to SMBG has been published to date.
To conduct a systematic review and meta-analysis of the impact of sSMBG on HbA1c, treatment modifications, behavioral and psychosocial outcomes, and; examine the moderating effects of sSMBG protocol characteristics on HbA1c.
Four databases searched (November 2020; updated: February 2022).
Inclusion criteria: non-randomized and randomized controlled trials (RCTs) and prospective observational studies; reporting effect of sSMBG on stated outcomes; among adults (≥18 years) with non-insulin-treated type 2 diabetes. Studies excluded if involving children or people with insulin-treated or other forms of diabetes.
Outcome data extracted, and risk of bias/quality assessed independently by two researchers. Meta-analysis was conducted for RCTs, and moderators explored (HbA1c only).
From 2,078 abstracts, k=23 studies were included (N=5,372). Risk of bias was evident and study quality was low. Outcomes assessed included: HbA1c (k=23), treatment modification (k=16), psychosocial/behavioral outcomes (k=12). Meta-analysis revealed a significant mean difference favoring sSMBG in HbA1c (-0·29%, 95% CI: -0·46 to -0·11, k=13) and diabetes self-efficacy (0.17%, 95% CI: 0.01 to 0.33, k=2). Meta-analysis revealed no significant moderating effects by protocol characteristics.
Findings limited by heterogeneity in study designs, intervention characteristics, and psychosocial assessments.
A small positive effect of sSMBG on HbA1c and diabetes self-efficacy was observed. Narrative synthesis of sSMBG intervention characteristics may guide future implementation.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208857, identifier CRD42020208857.
对于非胰岛素治疗的2型糖尿病成人患者，自我血糖监测（SMBG）被认为临床益处不大，但迄今为止尚未发表关于SMBG结构化方法的全面综述。
对自我血糖监测（sSMBG）对糖化血红蛋白（HbA1c）、治疗调整、行为和心理社会结局的影响进行系统综述和荟萃分析；并研究sSMBG方案特征对HbA1c的调节作用。
检索了四个数据库（2020年11月；更新于2022年2月）。
纳入标准：非随机和随机对照试验（RCT）以及前瞻性观察性研究；报告sSMBG对所述结局的影响；纳入非胰岛素治疗的2型糖尿病成人（≥18岁）。如果研究涉及儿童或接受胰岛素治疗的患者或其他形式糖尿病患者则排除。
提取结局数据，由两名研究人员独立评估偏倚风险/质量。对RCT进行荟萃分析，并探索调节因素（仅针对HbA1c）。
从2078篇摘要中，纳入了23项研究（N = 5372）。偏倚风险明显，研究质量较低。评估的结局包括：HbA1c（23项研究）、治疗调整（16项研究）、心理社会/行为结局（12项研究）。荟萃分析显示，在HbA1c方面有利于sSMBG的显著平均差异（-0.29%，95%CI：-0.46至-0.11，13项研究）以及糖尿病自我效能感方面（0.17%，95%CI：0.01至0.33，2项研究）。荟萃分析显示方案特征无显著调节作用。
研究结果受研究设计、干预特征和心理社会评估的异质性限制。
观察到sSMBG对HbA1c和糖尿病自我效能感有小的积极影响。对sSMBG干预特征的叙述性综合分析可能会指导未来的实施。
PROSPERO注册：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208857，标识符CRD42020208857。
