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Meta-analysis of individual patient data in randomised trials of self-monitoring of blood glucose in people with non-insulin treated type 2 diabetes.

Biomedical Sciences Research Institute Computer Science Research Institute Environmental Sciences Research Institute Nanotechnology & Advanced Materials Research Institute

Farmer , AJ, Perera , R, Ward , A, Heneghan , C, Oke , J, Barnett , AH, Chambers, C, Guerci, B, Coates, Vivien, Schwedes , U and O'Malley, S (2012) Meta-analysis of individual patient data in randomised trials of self-monitoring of blood glucose in people with non-insulin treated type 2 diabetes. British Medical Journal , 344 . pp. 1-11. [Journal article]

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URL: http://www.bmj.com/highwire/filestream/570365/field_highwire_article_pdf/0.pdf

DOI: doi: 10.1136/bmj.e486 (Published 27 February 2012) Page 6

Abstract

AbstractObjective To assess the effectiveness of self monitoring blood glucoselevels in people with non-insulin treated type 2 diabetes compared withclinical management without self monitoring, and to explore the effectsin specific patient groups.Design Meta-analysis based on individual participant data.Data sources Medline, Embase, and a recent systematic review of trialson self monitoring of blood glucose. Chief investigators of trials publishedsince 2000 were approached for additional information and individualpatient data.Inclusion criteria Randomised controlled trials in patients withnon-insulin treated type 2 diabetes comparing an intervention using selfmonitoring of blood glucose with clinical management not using selfmonitoring. Trials published from 2000 with at least 80 participants wereincluded.Data collection Individual patient data were collected from electronicfiles and checked for integrity.Analysis All randomised participants were analysed using the intentionto treat principle. A random effects model of complete cases was usedto assess efficacy, a sensitivity analysis comprised imputed data, andprespecified subgroup analyses were carried out for age, sex, previoususe of self monitoring, duration of diabetes, and levels of glycatedhaemoglobin (HbA1c) at baseline.Results 2552 patients were randomised in the six included trials. Amean reduction in HbA1c level of −2.7 mmol/mol (95% confidence interval−3.9 to −1.6; 0.25%) was observed for those using self monitoring ofblood glucose levels compared with no self monitoring at six months.The mean reduction in HbA1c level between groups was 2.0 mmol/mol(3.2 to 0.8; 0.25%) at three months (five trials) and 2.5 mmol/mol (4.1to 0.9; 0.35%) at 12 months (three trials). These estimates wereunchanged after imputing missing data, and estimates of effect in trialswith higher loss to follow-up or a possibility of co-intervention comparedwith those with lower loss to follow-up and no co-intervention did notdiffer significantly (P=0.21). The difference in HbA1c levels betweengroups was consistent across age, baseline HbA1c level, sex, and durationof diabetes, although the numbers of older and younger people andthose with HbA1c levels >86 mmol/mol (10%) were insufficient forinterpretation. No changes occurred in systolic blood pressure (−0.2 mmHg, 95% confidence interval −1.4 to 1.0), diastolic blood pressure (−0.1mm Hg, −0.9 to 0.6), or total cholesterol level (−0.1 mol/L, 95%confidence interval −0.2 to 0.1).Conclusions Evidence from this meta-analysis of individual patient datawas not convincing for a clinically meaningful effect of clinicalmanagement of non-insulin treated type 2 diabetes by self monitoringof blood glucose levels compared with management without selfmonitoring, although the difference in HbA1c level between groups wasCorrespondence to: A Farmer andrew.farmer@phc.ox.ac.ukExtra material supplied by the author (see http://www.bmj.com/content/344/bmj.e486?tab=related#webextra)Search termsFurther details of study characteristicsNo commercial

Item Type:Journal article
Faculties and Schools:Faculty of Life and Health Sciences > School of Nursing
Research Institutes and Groups:Institute of Nursing and Health Research
Institute of Nursing and Health Research > Managing Chronic Illness
ID Code:22890
Deposited By:Professor Vivien Coates
Deposited On:06 Aug 2012 14:31
Last Modified:25 Sep 2012 15:28

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