title: Reduction in self-monitoring of blood glucose in persons with type 2 diabetes results in cost savings and no change in glycemic control.
abstract: OBJECTIVE
  Recent Veterans Affairs (VA) guidelines recommend that persons with stable type 2 diabetes controlled on oral agents or diet therapy perform self-monitoring of blood glucose (SMBG) twice weekly. We assessed the impact of a modification of these guidelines on hemoglobin A1c (HbA1c) and monitoring cost.
  
  
  METHODS
  Retrospective, noncrossover clinical trial.
  
  
  METHODS
  We instructed persons with type 2 diabetes to perform SMBG testing according to modified adapted VA guidelines. We compared patients' baseline average testing frequency and HbA1c with those obtained during a 6-month interval beginning 2 months after implementation of the modified guidelines. The impact on the cost of monitoring was calculated.
  
  
  RESULTS
  At baseline, 913 of 1,213 SMBG users with diabetes on oral hypoglycemic agents had HbA1c tested (HbA1c = 7.83% +/- 1.34%); their frequency of SMBG was 1.36 +/- 0.95 strips per patient per day. Postimplementation, 974 of 1,278 persons with diabetes had HbA1c tested (HbA1c = 7.86% +/- 1.54%; P= .63 vs baseline); frequency of SMBG decreased by 46% to 0.74 +/- 0.50 strips per patient per day (P < .0001). At baseline, 154 of 254 SMBG users with diabetes on diet therapy had HbA1c tested (HbA1c = 6.85% +/- 0.97%); their frequency of SMBG was 1.07 +/- 0.90 strips per patient per day. Postimplementation, 177 of 282 diet-treated persons with diabetes had HbA1c tested (HbA1c = 6.78% +/- 1.20%; P = .56 vs baseline); frequency of SMBG decreased by 35% to 0.70 +/- 0.51 strips per patient per day (P < .0001). Similar findings were observed in a cohort of 421 drug-treated patients with paired HbA1c data before and after implementation, and a cohort of 50 diet-treated patients with paired HbA1c data. Linear regression analysis showed no significant impact on individuals' HbA1c with reduction in strip use. Average monthly cost savings were $8,800, or $6.37 per patient per month.
  
  
  CONCLUSIONS
  This program decreased the frequency of SMBG in persons with type 2 diabetes, resulting in substantial cost savings without affecting glucose control.
authors.affiliation: Pharmacy Services, VA Northern California Health Care System, Martinez 94553, USA.
authors.forename: Joy L
authors.initials: JL
authors.lastname: Meier
authors.forename: Arthur L M
authors.initials: AL
authors.lastname: Swislocki
authors.forename: Julio R
authors.initials: JR
authors.lastname: Lopez
authors.forename: Robert H
authors.initials: RH
authors.lastname: Noth
authors.forename: Patricia
authors.initials: P
authors.lastname: Bartlebaugh
authors.forename: David
authors.initials: D
authors.lastname: Siegel
mesh_terms: D015190:Blood Glucose Self-Monitoring / Q000191:economics / Q000592:standards*; D002140:California; D015331:Cohort Studies; D003363:Cost Control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D006442:Glycated Hemoglobin / Q000032:analysis; D006787:Hospitals, Veterans; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents