The efficacy of self-monitoring of blood glucose in NIDDM subjects - A criteria-based literature review

OBJECTIVE - To determine the efficacy of self-monitoring of blood glucose (SMBG) in NIDDM patients from studies published during the years 1976-1996. RESEARCH DESIGN AND METHODS - A systematic literature search was conducted. The selected studies were assessed for their methodological quality and reviewed on the reported efficacy and on the following topics: characteristics of the study population, follow-up duration, nature of the efficacy measures, use of a therapy decision scheme, nature of the intervention, nature of the SMBG device, patient instruction, type of SMBG regime, assessment of the frequency of self-measurement, and whether feedback was given on the measured glucose levels. Studies with positive conclusions on the efficacy of SMBG were compared with studies with negative conclusions on the basis of these characteristics to determine which factors could have contributed to the results. RESULTS - Of the 11 studies identified, only 4 met all quality criteria. Six of the studies were randomized controlled trials, of which only one showed positive conclusions regarding the efficacy of SMBG. Although the studies differed on most topics, no factor could be identified as responsible for the results of the studies. CONCLUSIONS - The efficacy of SMBG in NIDDM patients is still questionable and should be tested in a rigorous high-quality randomized controlled trial, for which some recommendations are given.