Authors' objectives:

The aim of this report is to critically consider the available information on self-monitoring of blood glucose (SMBG), and thereby support the further development of diabetes care. The report contains a narrative expert review on SMBG and diabetes in Finland in the early years of the first decade of the 21st century. In addition, the report contains a systematic literature review which scrutinizes the available scientific evidence on the effectiveness and cost-effectiveness of SMBG.

Authors' results and conclusions: A total of 16 scientific studies that fulfilled the inclusion criteria of the systematic review were identified. Only one study regarding SMBG in type 1 diabetes was included in the review. Generally, the scientific literature focusing on SMBG as the main intervention in treatment of type 1 diabetes is scarce. This is probably explained by the use of insulin replacement therapy, which in practice necessitates the use of SMBG. Therefore, in type 1 diabetes the SMBG can be regarded as an essential part of an effective treatment strategy. Research in the 1990s and early 2000s has not focused on the effect of plain SMBG in type 1 diabetes. A total of 15 studies on type 2 diabetes were identified, seven of which were prospective clinical trials. Based on these studies, one can conclude that the glycemic control in type 2 diabetes can be improved through SMBG. The beneficial effect on glycemic control has been found in people with diabetes (PWD) that use oral medication or diet as treatment. In one of the studies, a positive effect on glycemic control was not found. No studies were found that would involve only persons with type 2 diabetes on insulin treatment and that would fulfil the inclusion criteria of the review. Through similar reasoning as in the context of type 1 diabetes, one can, however, assume that SMBG enables effective insulin regimen and consequently is an effective treatment method also for such patients. SMBG was not the only intervention in the included studies. Self-monitoring was usually accompanied by patient education or active follow-up routines. Consequently, the optimal beneficial effect of SMBG on the glycemic control probably requires its active integration into the comprehensive diabetes management and proper instruction for such management. For some persons with type 2 diabetes that are not treated with insulin, self-monitoring of urine glucose may be a feasible, though not as sensitive, alternative self-monitoring method (e.g. if the person is unable or unwilling to perform SMBG). Self-monitoring of urine glucose does not provide a means to detect hypoglycemia. The type of diabetes and changes in the treatment, as well as each person's individual characteristics and life conditions, bring about a considerable variation in the frequency of self-monitoring through which an optimal glycemic control can be achieved. Even for an individual person, the need for self-monitoring may vary across different periods. Individual needs should be adequately taken into account in treatment, as well as in the planning and implementation of self-monitoring.

Authors' recommendations: Based on the available scientific literature, we conclude that the glycemic control in diabetes can be improved through the use of SMBG independent of the type of diabetes. However, beneficial effects are also most likely dependent on the success of the other elements of diabetes management, i.e. of the treatment as a whole. In the discussion section of this report, several key topics that deserve special attention to ensure beneficial effects are discussed. Such topics include the role of SBMG in diabetes management; patient education; responsibilities and education of professionals; variety of devices; and computer-assisted treatment.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://finohta.stakes.fi/NR/rdonlyres/6782C42D-A8E2-400A-B53E-023E28DA2822/0/r024f.pdf

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Finland

Organisation Name: Finnish Coordinating Center for Health Technology Assessment

Contact Address: Finnish Office for Health Care Technology Assessment (Finohta)

Contact Name: .

Contact Email: fincchta@ppshp.fi

Copyright: Finnish Office for Health Care Technology Assessment