• Intervention
    What is the relationship between self-monitoring of blood glucose and metabolic outcomes in persons with type 2 diabetes?
    • Conclusion

      Sixteen type 2 diabetes studies that involved SMBG and glycemic control were reviewed. SMBG, compared to non-SMBG, is associated with greater improvement in A1C when it is a part of a structured education program where subjects use the information to make changes in their management program.  Evidence on frequency and duration of SMBG is inconclusive.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Self-Monitoring of Blood Glucose 2006
       
  • Monitoring and Evaluation
    What is the relationship between continuous glucose monitoring and metabolic outcomes in persons with type 1 and type 2 diabetes?
    • Conclusion

      Six studies using continuous glucose monitoring (CGM) in subjects with diabetes report improvements in glycemic control. Seven studies report improvements in hyper- and hypoglycemic ranges.   Data derived from CGM can be used to modify food or insulin therapy that will improve metabolic outcomes; however, it is currently unclear if use of information from CGM will improve metabolic outcomes significantly more than use of information derived from SMBG: two RCTs found that both methods significantly improved A1C; one RCT found that only CGM significantly improved A1C; and one RCT found that only CGM significantly reduced hyperglycemia. In a data-gathering study, both methods gave similar mean glucose profiles and associations with A1C. Two RCTs found no significant differences between methods in improving hypoglycemia; however two other RCTs found that CGM reduced duration of hypoglycemia vs. SMBG.  Five studies present pattern information from the wearing of CGM devices.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Continuous Glucose Monitoring 2006
       
    What is the relationship between self-monitoring of blood glucose and metabolic outcomes in persons with type 1 diabetes?
    • Conclusion

      Prospective intervention studies in subjects with type 1 diabetes that included self-management training and adjustment of insulin doses based on Self-Monitoring of Blood Glucose (SMBG) showed significant improvement in glycemic control compared to study control group.  More frequent SMBG (3 to 8 times daily) was also associated with better glycemic control regardless of diabetes type or therapy.

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    • Search Plan and Results: Self-Monitoring of Blood Glucose 2006