LAUSR

BACKGROUND The benefit of self-monitoring of blood glucose in reducing HbA1c in non-insulin-treated participants remains unclear. HbA1c may be improved in this population with self-monitoring. OBJECTIVE To conduct a meta-analysis of the effect in non-insulin-treated participants with type 2 diabetes of self-monitoring of blood glucose versus usual care, structured versus unstructured self-monitoring of blood glucose on glycemic control, and use of self-monitoring of blood glucose readings used to adjust therapy versus usual care. METHODS Medline, Embase, and Cochrane Central were electronically searched to identify articles published from January 1, 2000, to June 3, 2020. Trials investigating changes in HbA1c were selected. Screening was performed independently by two investigators. Two investigators extracted HbA1c at baseline and follow-up for each trial. RESULTS Nineteen trials involving 4,965 participants were included. Overall, self-monitoring of blood glucose reduced HbA1c. Preplanned subgroup analysis showed that using self-monitoring of blood glucose readings to adjust therapy contributed significantly to the reduction. No significant improvement in HbA1c was shown in self-monitoring of blood glucose without therapy adjustment. The same difference was observed in structured versus unstructured self-monitoring of blood glucose. DISCUSSION HbA1c is improved with therapy adjustment based on structured self-monitoring of blood glucose readings. Implications are for clinicians to prescribe structured self-monitoring of blood glucose to modify therapy adjustment based on the readings and not prescribe unstructured self-monitoring of blood glucose. Participants with suboptimal glycemic control may benefit most. A self-monitoring of blood glucose regimen that improves clinical- and cost-effectiveness is presented. Future studies can investigate this regimen specifically.