제 2형 당뇨 환자에서 자가혈당측정의 임상적 유용성 : 체계적문헌고찰 및 메타분석
Clinical Benefits of Self-monitoring of Blood Glucose in Non-insulin Treated Patients with Type 2 Diabetes : A systematic Review and Meta-analysis
2
조회
0
다운로드
6
인용
0
참고문헌
키워드
초록
While Self-monitoring of blood glucose (SMBG) has been recommended in some diabetes mellitus (DM) patients population according to the 2010 American Diabetes Association (ADA), 2007 Korean Diabetes Association (KDA), 2005International Diabetes Federation guideline, it is excluded from a routine insurance coverage for outpatients in Korea. The objective of this study is to meta-analyze the impact of SMBG on HbA1c in non insulin-treated diabetes mellitus (NIT) DM patients. Published clinical literatures were identified through electronic database searches from inception and until May 2010. Studies were selected if they met the following inclusion criteria: 1) randomized controlled trials (RCTs), 2) comparing SMBG with non-SMBG in NIT type 2 diabetes, 3) measuring HbA1c as an outcome. Literature qualities were assessed by the Scottish Intercollegiate Guidelines Network Checklist. The mean difference of HbA1c between the 2 groups was pooled from non-heterogeneous 6 RCTs by meta-analysis using Review Manger (RevMan)Version 5.0 program. Pooled results demonstrated that SMBG is associated with a statistically significant improvement in glycemic control (mean HbA1c difference -0.23, 95%CI -0.32, -0.13). Sensitivity analysis showed that glycemic controls were significantly improved in patients with shorter study duration, more frequent self-monitoring, higher baseline HbA1c value, and without prior SMBG experiences. Conclusively SMBG is effective in improving glycemic control in NIT DM patients, but additional evidences from further researches in Korean patients and cost-effectiveness analysis would be necessary to make a suggestion for coverage expansion
Abstract
While Self-monitoring of blood glucose (SMBG) has been recommended in some diabetes mellitus (DM) patients population according to the 2010 American Diabetes Association (ADA), 2007 Korean Diabetes Association (KDA), 2005International Diabetes Federation guideline, it is excluded from a routine insurance coverage for outpatients in Korea. The objective of this study is to meta-analyze the impact of SMBG on HbA1c in non insulin-treated diabetes mellitus (NIT) DM patients. Published clinical literatures were identified through electronic database searches from inception and until May 2010. Studies were selected if they met the following inclusion criteria: 1) randomized controlled trials (RCTs), 2) comparing SMBG with non-SMBG in NIT type 2 diabetes, 3) measuring HbA1c as an outcome. Literature qualities were assessed by the Scottish Intercollegiate Guidelines Network Checklist. The mean difference of HbA1c between the 2 groups was pooled from non-heterogeneous 6 RCTs by meta-analysis using Review Manger (RevMan)Version 5.0 program. Pooled results demonstrated that SMBG is associated with a statistically significant improvement in glycemic control (mean HbA1c difference -0.23, 95%CI -0.32, -0.13). Sensitivity analysis showed that glycemic controls were significantly improved in patients with shorter study duration, more frequent self-monitoring, higher baseline HbA1c value, and without prior SMBG experiences. Conclusively SMBG is effective in improving glycemic control in NIT DM patients, but additional evidences from further researches in Korean patients and cost-effectiveness analysis would be necessary to make a suggestion for coverage expansion
참고문헌 (32)
- 보건복지부, "2001년도국민건강·영양조사-만성질병편", ~ (2002)
- "우리나라 당뇨병의 관리현황과 의료비용, 사망 (2005년 전국표본조사 심층분석결과) 보도자료"[URL]
- 국민건강보험공단, "2008 건강보험통계연보", ~ (2009)
- 박태선, "특집", 당뇨병 관리의 일반적 원칙, 2008, pp.51(9), 806~812[DOI]
- "당뇨병 치료의 교육지침"[URL]
- "당뇨병진료지침"[URL]
- "Guideline for Type 2 Diabetes"[URL]
- American Diabetes Association (ADA), "Standards of medical care in diabetes", V. Diabetes Care, 33(Suppl 1), pp.S16~S29 (2010)
- 심강희, "당뇨병 관련 의료 소모품의 비용", 제 21차대한당뇨병학회춘계학술대회자료집 (2008)
- "건강보험, 암 및 치과분야의 보장성 확대 추진 보도자료"[URL]
- Bowker SL, "Lack of insurance coverage for testing supplies is associated with poorer glycemic control in patients with type 2 diabetes", CMAJ, 171(1), pp.39~43 (2004)
- Landman GW, "The relationship between glycaemic control and mortality in patients with type 2 diabetes in general practice (ZODIAC-11)", Br J Gen Pract, 60(572), pp.172~175 (2010)
- Elley CR, "Glycated haemoglobin and cardiovascular outcomes in people with Type 2 diabetes: a large prospective cohort study", Diabet Med, 25, pp.1295~12301 (2008)
- Adler AI, "UKPDS 59: hyperglycemia and other potentially modifiable risk factors for peripheral vascular disease in type 2 diabetes", Diabetes Care, 25(5), pp.894~899 (2002)
- "Scottish Intercollegiate Guidelines Network (SIGN) 50: A guideline developer's handbook Annex C: Critical appraisal -Notes and checklists Methodology Checklist 2: Randomised Controlled Trials"[URL]
- "Cochrane Handbook for Systematic ReviewstemaInterventions. Part 3: Special topics. Chapter 16: Special topics in statistics"[URL]
- Farmer AJ, "Blood glucose self-monitoring in type 2 diabetes: a randomised controlled trial", Health Technol Assess, 13(15), pp.1~50 (2009)
- Barnett AH, "The efficacy of self-monitoring of blood glucose in the management of patients with type 2 diabetes treated with a gliclazide modified release-based regimen. A multicentre, randomized, parallel-group, 6-month evaluation (DINAMIC 1 study)", Diabetes Obes Metab, 10(12), pp.1239~1247 (2008)
- O'Kane MJ, "Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial", BMJ, 336(7654), pp.1174~1177 (2008)
- Davidson MB, "The effect of self monitoring of blood glucose concentrations on glycated hemoglobin levels in diabetic patients not taking insulin: a blinded, randomized trial", Am J Med, 118(4), pp.422~425 (2005)
- Guerci B, "Self-monitoring of blood glucose significantly improves metabolic control in patients with type 2 diabetes mellitus: the Auto-Surveillance Intervention Active (ASIA) study", Diabetes Metab, 29(6), pp.587~594 (2003)
- Schwedes U, "SMBG Study Group. Meal-related structured self-monitoring of blood glucose: effect on diabetes control in non-insulin-treated type 2 diabetic patients", Diabetes Care, 25(11), pp.1928~1932 (2002)
- Poolsup N, "Metaanalysis of the benefits of self-monitoring of blood glucose on glycemic control in type 2 diabetes patients: an update", Diabetes Technol Ther, 11(12), pp.775~784 (2009)
- Allemann S, "Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis", Curr Med Res Opin, 25(12), pp.2903~2913 (2009)
- Towfigh A, "Selfmonitoring of blood glucose levels in patients with type 2 diabetes mellitus not taking insulin: a meta-analysis", Am J Manag Care, 14(7), pp.468~475 (2008)
- Jansen JP, "Self-monitoring of glucose in type 2 diabetes mellitus: a Bayesian meta-analysis of direct and indirect comparisons", Curr Med Res Opin, 22(4), pp.671~681 (2006)
- Sarol JN Jr, "Selfmonitoring of blood glucose as part of a multi-component therapy among non-insulin requiring type 2 diabetes patients: a meta-analysis (1966-2004)", Curr Med Res Opin, 21(2), pp.173~184 (2005)
- 하정미, "제2형 당뇨병환자의 자가혈당측정, 식이, 신체활동, 자가간호행위, 자기효능감의 혈관합병증과의 상관관계", 제 33차 대한당뇨병학회 추계학술대회자료집 (2007)
- Weber C, "Cost impact of blood glucose self-monitoring on complications of type 2 diabetes: a Swiss perspective (ROSSO study No. 11)", Swiss Med Wkly, 137(39), pp.545~550 (2007)
- Cameron C, "Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin", CMAJ, 182(1), pp.28~34 (2010)
- Monami M, "Comparison of different drugs as add-on treatments to metformin in type 2 diabetes: a meta-analysis", Diabetes Res Clin Pract, 79(2), pp.196~203 (2008)
- Thomas DE, "Exercise for type 2 diabetes mellitus", Cochrane Database Syst Rev, 3, pp.CD002968~ (2006)