Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes Who Are Not Using Insulin
A systematic review
- Laura M.C. Welschen, MSC12,
- Evelien Bloemendal, MSC12,
- Giel Nijpels, MD, PHD12,
- Jacqueline M. Dekker, PHD1,
- Robert J. Heine, MD, PHD13,
- Wim A.B. Stalman, MD, PHD12 and
- Lex M. Bouter, PHD1
- 1Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, the Netherlands
- 2Department of General Practice, VU University Medical Center, Amsterdam, the Netherlands
- 3Department of Endocrinology, Diabetes Center, VU University Medical Center, Amsterdam, the Netherlands
- Address correspondence and reprint requests to Laura M.C. Welschen, MSc, Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands. E-mail: www.emgo.nl or
A strict glycemic control reduces the risk of the development of micro- and macrovascular complications (1–3). In the U.K. Prospective Diabetes Study, each 1% reduction in HbA1c was associated with a 37% decrease in risk for microvascular complications and a 21% decrease in risk for any end point or death related to diabetes (3). In clinical practice, a 3-monthly visit to the general practitioner is recommended for the assessment of glycemic control (4). There is now much debate on the effectiveness of self-monitoring of blood glucose (SMBG) as a tool in the self-management of diabetic patients (1,5,6).
SMBG aims at collecting information on blood glucose levels at different time points during the day and allows for the timely identification of high levels. SMBG has proven effective for patients with type 1 diabetes (7–9) and patients with type 2 diabetes who are using insulin (10–12) because the information about a patient’s glucose level is useful to refine and adjust insulin dosages, resulting in an improved glycemic control. It has been suggested that patients with type 2 diabetes who are not using insulin might also benefit from SMBG (13). These patients might cope more independently with their disease when using SMBG, and they might achieve a better understanding about the factors that affect their disease and potentially a better perceived quality of life. SMBG might also improve adherence to pharmacological treatment and motivate patients to make appropriate lifestyle changes (10,14).
Until 2001, several reviews investigated the literature on the effectiveness of SMBG in patients with type 2 diabetes who are not using insulin and reported no clear effects of SMBG on HbA1c (1,5,6,15). Other outcome measures like quality of life …