The impact of structured self-monitoring of blood glucose on clinical, behavioral, and psychosocial outcomes among adults with non-insulin-treated type 2 diabetes: a systematic review and meta-analysis

Elizabeth Holmes-Truscott; Shaira Baptista; Mathew Ling; Eileen Collins; EIif I Ekinci; John Furler; Virginia Hagger; Jo-Anne Manski-Nankervis; Caroline Wells; Jane Speight

doi:10.3389/fcdhc.2023.1177030

The impact of structured self-monitoring of blood glucose on clinical, behavioral, and psychosocial outcomes among adults with non-insulin-treated type 2 diabetes: a systematic review and meta-analysis

Front Clin Diabetes Healthc. 2023 Apr 20:4:1177030. doi: 10.3389/fcdhc.2023.1177030. eCollection 2023.

Authors

Elizabeth Holmes-Truscott^{1

2}, Shaira Baptista^{1

2}, Mathew Ling^{1

3}, Eileen Collins⁴, EIif I Ekinci^{5

6}, John Furler⁷, Virginia Hagger^{2

8}, Jo-Anne Manski-Nankervis^{6

7}, Caroline Wells⁹, Jane Speight^{1

2}

Affiliations

¹ School of Psychology, Deakin University, Geelong, VIC, Australia.
² The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
³ Neami National, Preston, VIC, Australia.
⁴ Diabetes Victoria, Melbourne, VIC, Australia.
⁵ Department of Medicine, Austin Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.
⁶ The Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, VIC, Australia.
⁷ Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia.
⁸ School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, VIC, Australia.
⁹ Diabetes Tasmania, Hobart, TAS, Australia.

Abstract

Background: 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.

Purpose: 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.

Data sources: Four databases searched (November 2020; updated: February 2022).

Study selection: 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.

Data extraction and analysis: Outcome data extracted, and risk of bias/quality assessed independently by two researchers. Meta-analysis was conducted for RCTs, and moderators explored (HbA1c only).

Data synthesis: 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.

Limitations: Findings limited by heterogeneity in study designs, intervention characteristics, and psychosocial assessments.

Conclusion: A small positive effect of sSMBG on HbA1c and diabetes self-efficacy was observed. Narrative synthesis of sSMBG intervention characteristics may guide future implementation.

Prospero registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208857, identifier CRD42020208857.

Keywords: HbA1c; behavioral outcomes; meta-analysis; psychological outcome; self-monitor of blood glucose (SMBG); structured self-monitoring of blood glucose; systematic review; type 2 diabetes.

Publication types

Systematic Review

Grants and funding

This review was partially funded by the National Diabetes Services Scheme (Type 2 diabetes: Starting Insulin National Priority Area), an Australian Government initiative administered by Diabetes Australia. EH-T and JS are supported by the core funding to the Australian Centre for Behavioural Research in Diabetes (ACBRD) provided by the collaboration between Diabetes Victoria and Deakin University. SB was supported, in part, by an unrestricted grant from Diabetes Australia.