Meta analysis with qualitative synthesis on the effects of self-monitoring of blood glucose among people with type 2 diabetes: methodological perspectives on qualitative data in reviews of effects

Article type
Authors
Lockwood C, Konno R
Abstract
Background: The Cochrane guidance on including qualitative evidence in reviews of effects, as described in Chapter 20 of the Cochrane Handbook, was used to inform the conduct of a review that identified qualitative data along with randomised controlled trials on the effects of self monitoring of blood glucose on glycaemic control. Qualitative data assist with understanding how people respond to complex interventions, why they interact with interventions in particular ways, and explore the impact of interventions from the individual’s perspective. Objectives: To describe the process of integrating qualitative data within a review of effects through a recently completed systematic review. Methods: An a priori protocol established that participants would be adults with type 2 diabetes not using insulin. No other participant exclusion criteria were utilised. Randomised controlled trials were considered for inclusion. Qualitative studies or data embedded in RCTs identified during the search for RCTs were also included. The intervention of interest was self-monitoring of blood Oral session 13 glucose (SMBG), and the primary outcome measure was glycaemic control via HbA1c or capillary glucose monitoring. All studies were subject to standardised appraisal, extraction, and, where appropriate, meta-analysis or meta aggregation as described in the relevant sections of the Cochrane Handbook for Systematic Reviews of Interventions. Results: 10 RCTs and 10 qualitative papers were included in the final analysis. Meta analysis did not find a statistically significant benefit of SMBG for glycaemic control. Meta aggregation of qualitative findings though indicated many people find SMBG to be personally useful in helping them engage one’s own glycaemic control and lifestyle related needs. Conclusions: Meta aggregation is a useful and practical method for managing qualitative data. The findings can inform our understanding of how people perceive and value SMBG in different ways and this review illustrates how readily qualitative data can be incorporated into a review of effects.