Blood glucose monitoring in T2 DM - Is it cost-effective?

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Blood glucose monitoring in T2 DM - Is it cost-effective?


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Old 09-02-2010, 09:15   #1
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Default Blood glucose monitoring in T2 DM - Is it cost-effective?

A friend of mine sent me this abstract. Thought it may be of some use to those of us with T2 DM who are monitoring BG every day.

Simon J, Gray A, Clarke P, Wade A, Neil A, Farmer A; Diabetes Glycaemic Education
and Monitoring Trial Group. Cost effectiveness of self monitoring of blood glucose in patients with
non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM
trial. BMJ. 2008 May 24;336(7654):1177-80.
OBJECTIVE: To assess the cost effectiveness of self monitoring of blood glucose
alone or with additional training in incorporating the results into self care, in
addition to standardised usual care for patients with non-insulin treated type 2
diabetes. DESIGN: Incremental cost utility analysis from a healthcare
perspective. Data on resource use from the randomised controlled diabetes
glycaemic education and monitoring (DiGEM) trial covered 12 months before
baseline and 12 months of trial follow-up. Quality of life was measured at
baseline and 12 months using the EuroQol EQ-5D questionnaire. SETTING: Primary
care in the United Kingdom. PARTICIPANTS: 453 patients with non-insulin treated
type 2 diabetes. INTERVENTIONS: Standardised usual care (control) compared with
additional self monitoring of blood glucose alone (less intensive self
monitoring) or with training in self interpretation of the results (more
intensive self monitoring). MAIN OUTCOME MEASURES: Quality adjusted life years
and healthcare costs (sterling in 2005-6 prices). RESULTS: The average costs of
intervention were pound89 (euro113; $179) for standardised usual care, pound181
for less intensive self monitoring, and pound173 for more intensive self
monitoring, showing an additional cost per patient of pound92 (95% confidence
interval pound80 to pound103) in the less intensive group and pound84 ( pound73
to pound96) in the more intensive group. No other significant cost difference was
detected between the groups. An initial negative impact of self monitoring on
quality of life occurred, averaging -0.027 (95% confidence interval-0.069 to
0.015) for the less intensive self monitoring group and -0.075 (-0.119 to -0.031)
for the more intensive group. CONCLUSIONS: Self monitoring of blood glucose with
or without additional training in incorporating the results into self care was
associated with higher costs and lower quality of life in patients with
non-insulin treated type 2 diabetes. In light of this, and no clinically
significant differences in other outcomes, self monitoring of blood glucose is
unlikely to be cost effective in addition to standardised usual care.

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T2 DM diagnosed 12th July 2010
Metformin 1 gm twice a day
Glimepride 4 mg once a day
Glucobetic 1 twice a day
Fish oil 1gm once a day
Rosuvastatin 40 mg once a day
Ezetrol 1 tab once a day
Perindropril 1 tab once a day.

Hb1Ac was 8.6% on 12th July 2010. It is 6.2% on 28th Oct 2010.
Cholesterol 2.4 mmol/L
HDL Cholesterol 0.9 mmol/L
Triglycerides 1.5 mmol/L
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Old 09-06-2010, 20:37   #2
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Increased self monitoring in and of itself can have no impact on diabetes outcome other than increased cost and frustration. What one does with the information gleaned from the monitoring is what impacts the outcome. The abstract does not detail what participants were told to do with their self monitoring data; Did they make dietary modifications such as reduction or elimination of starchy carb intake? Did they incorporate exercise into their self-care program? Testing without taking follow up action is indeed pointless...

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Old 09-07-2010, 04:04   #3
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I believe Jen is correct. Most studies do not cover many of the important parts of why it is important and what we should learn from increased testing. Foods that should be reduced or eliminated, when your oral medications are taking you low - yes, most can cause lows.

Most studies do not even mention exercise. They don't dare as the funding would go away if people could show that exercise and good nutrition gets them off diabetes medications. This appears to be another attempt to justify taking testing supplies away from the people that could actually use them if they were taught what to look for and how to use the testing results and if nutrition was actually made a part of this and add exercise.

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Old 09-08-2010, 18:27   #4
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Regular testing is what helped me get my A1c into normal range. Jen is absolutely right that the information itself means nothing unless the diabetic knows what to do with it.

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Old 09-08-2010, 18:54   #5
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Quote:
Originally Posted by Miss_Blue View Post
Regular testing is what helped me get my A1c into normal range. Jen is absolutely right that the information itself means nothing unless the diabetic knows what to do with it.
Welcome back, Addie! I'm happy to meet you . . . glad to have you with us again & hope you'll be coming around often.




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Old 09-08-2010, 19:10   #6
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Quote:
Originally Posted by Shanny View Post
Welcome back, Addie! I'm happy to meet you . . . glad to have you with us again & hope you'll be coming around often.
Thanks, Shanny!

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