DM: Blood Glucose Self-Monitoring (2007)
- Randomized controlled trials
- Trial compared a diabetes management strategy with and without SMBG
- Adult patients 18 years and older
- Type 2 diabetes
- Non-insulin use
- Trial must have data of A1C from baseline and post-intervention
- Trials reported in English, or translated to English
- Studies with populations of type 1 diabetes
- Gestational diabetes studies
- Maturity-onset diabetes in the young (MODY) studies
- Studies who enrolled pregnant subjects
- Studies who enrolled those injecting insulin
- Studies who enrolled those taking troglitazone
- Studies who enrolled those taking any other experimental medication
Recruitment
- Data base searches done using various data bases including MEDLINE (1966-2004).
- Potential studies to be included in the meta-analysis were reviewed for quality based on specific criteria.
- Data was extracted from the selected studies
- Quality of the articles assessed using modified version of criteria specified by Cochrane Collaboration
Design
- Meta-analysis
Blinding used (if applicable)
- Not applicable
Intervention (if applicable)
- Not applicable
Statistical Analysis
- The measure of effect of SMBG was defined as the difference in the reduction from baseline to post-intervention, of mean A1C levels between SMBG and non-SMBG groups.
- The summary measure of effect and its 95% confidence interval were computed under fixed and random effects models.
- Chi-square test for heterogeneity was performed.
Timing of Measurements
- Baseline and post-intervention. Duration of studies varied from 12 weeks to 44 weeks.
Dependent Variables
- A1C
Independent Variables
- SMBG
- Non-SMBG
Control Variables
- Not identified
Initial N: 680 studies found with the database search; 296 were identified as possible sources of relevant information
Attrition (final N): 8 studies met the inclusion/exclusion criteria to be used in this meta-analysis, representing 1307 subjects
Age: see below
Ethnicity: not mentioned
Other relevant demographics: see below
Anthropometrics:
Location: Not discussed
Studies in Meta-analysis | Age in years | Duration of diabetes |
Fontbonne et al, 1989
|
54.5 ± 10.7 56.3 ± 9.1 |
12.2 ± 6.6 years 12.7 ± 0.8 years |
Estey et al, 1990
|
56.2 ± 11.1 54.2 ± 13.3 |
not provided not provided |
Muchmore et al, 1994
|
57.3 ± 2.3 60.1 ± 2.2 |
5.7 ± 1.4 years 5.2 ± 1.4 years |
Jaber et al, 1996
|
59 ± 12 65 ± 12 |
6.8 ± 6.5 years 6.2 ± 4.8 years |
Schwedes et al, 2002
|
58.7 ± 7.6 60.5 ± 6.6 |
5.46 ± 4.77 years 5.22 ± 3.94 years |
Guerci et al, 2003
|
60.9 ± 9.4 62.2 ± 9.1 |
92.3 ± 75.0 months 100.8 ± 76.6 months |
Davidson et al, 2004
|
49.8 ± 11.2 50.9 ± 11.0 |
5.5 ± 4.7 years 5.8 ± 5.8 years |
Kwon et al, 2004
|
53.88 ± 9.53 54.78 ± 9.96 |
5.58 ± 4.85 years 5.51± 4.83 years |
Studies in Meta-analysis | Difference in reduction between groups (SMBG reduction minus non-SMBG group) |
Fontbonne et al, 1989 |
0.140 |
Estey et al, 1990 |
-0.400 |
Muchmore et al, 1994 |
-0.690 |
Jaber et al, 1996 |
-1.551 (p<0.05) |
Schwedes et al, 2002 |
-0.460 (p<0.05) |
Guerci et al, 2003 |
-0.280 (p<0.05) |
Davidson et al, 2004 |
-0.230 |
Kwon et al, 2004 |
-0.840 (p<0.05) |
Other Findings
SMBG as a part of a multi-component management strategy produced an A1C reduction of -0.39% (95% CI: -0.54%, -0.23%) under the fixed effects model, and -0.42% (95% CI: -0.63%, -0.21%) under the random effects model, when compared to therapies that did not include SMBG.
Heterogeneity among studies was not statistically significant.
Mean testing frequency of the 8 studies included in this meta-analysis was about 5-7 times per week.
Quality Criteria Checklist: Review Articles
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Relevance Questions | |||
1. | Will the answer if true, have a direct bearing on the health of patients? | Yes | |
2. | Is the outcome or topic something that patients/clients/population groups would care about? | Yes | |
3. | Is the problem addressed in the review one that is relevant to dietetics practice? | Yes | |
4. | Will the information, if true, require a change in practice? | No | |
Validity Questions | |||
1. | Was the question for the review clearly focused and appropriate? | Yes | |
2. | Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? | Yes | |
3. | Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? | Yes | |
4. | Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? | Yes | |
5. | Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? | Yes | |
6. | Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? | Yes | |
7. | Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? | Yes | |
8. | Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? | Yes | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? | Yes | |
10. | Was bias due to the review's funding or sponsorship unlikely? | Yes | |