Self-monitoring of blood glucose levels in patients with type 2 diabetes mellitus not taking insulin: a meta-analysis.

A ccording to the World Health Organization, 1 at least 180 million people worldwide have diabetes mellitus (DM). The National Diabetes Information Clearinghouse estimates that DM costs $132 billion in the United States every year.2 Given these estimates along with the projection that the worldwide incidence of DM will double in the next 20 years,1 research into better management of this chronic disease is important. Glucose control along with blood pressure and lipid control is a main goal of DM management. In addition to pharmaceutical agents, an advocated method to achieve better glucose control is self-monitoring of blood glucose (SMBG) levels. For patients with DM taking insulin, SMBG has generally been accepted as necessary to help monitor the effect of insulin on daily blood glucose levels, with adjustments in dosage made in response to SMBG values. However, evidence supporting the use of SMBG for patients with DM not requiring insulin is not as clear. Self-monitoring of blood glucose levels is postulated to have a beneficial effect on glucose levels in patients not taking insulin by promoting dietary and lifestyle changes that a patient may make as a response to feedback provided by blood glucose results.3-6 Prior trials and systematic reviews have reached conflicting results, with 6 trials4,5,7-10 and 3 reviews11-13 reporting benefits and 3 trials3,6,14 and 3 reviews15-17 reporting no benefits. With an estimated cost of $466 million for Medicare alone, establishing the efficacy or lack of efficacy of SMBG represents an important goal for providers and payers interested in optimizing management of this condition. Because new larger and better-quality trials of SMBG continue to appear, we undertook a metaanalysis to provide the best curr nt estim te of the efficacy of SMBG in patients with type 2 DM not taking insulin.