Self blood glucose monitoring in type 2 diabetes. A financial impact analysis based on UK primary care.
BACKGROUND
UK consensus guidelines recommend limited use of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes using diet and exercise, metformin and/or a glitazone. This analysis quantifies the usage of and costs associated with SMBG in type 2 diabetes according to treatment regimen.


METHODS
Prevalence data for diabetes were assessed using UK Quality and Outcomes Framework returns for 2006/2007. Data on current SMBG prescribing expenditure were extracted from UK Prescription Pricing Agency Data for 2007. Prescribing data were extracted from the records of 40,651 patients with diabetes on the IMS Disease Analyzer (MediPlus) database. These were combined to arrive at mean usage and expenditure data per patient, broken down by treatment type. The analysis assumes that it is appropriate to use patients' treatment regimen alone to compare the frequency of SMBG in clinical practice with the frequency recommended in treatment guidelines; it does not take into account other valid reasons for SMBG.


RESULTS
Mean national expenditure on SMBG was 73.64 pound sterling per patient per year. Estimated mean weekly test strip usage by treatment was 2.5 (diet), 2.6 (glitazone monotherapy), 3.1 (metformin monotherapy) and 3.5 (sulphonylurea monotherapy). Combination oral therapy ranged from 3.3 to 4.1. Mean annual expenditure in patients with an identified treatment type was 62.06 pound sterling per patient, ranging from 9.83 pound sterling for diet-treated patients to 37.87 pound sterling for those on triple therapy, with insulin-treated patients incurring costs 3-5 times higher.


CONCLUSIONS
Based on the assumptions that the treatment regimen is the sole factor in determining the appropriate level of SMBG frequency, this study demonstrates that the use of SMBG exceeds current guidelines in certain treatment groups. The study estimates that the potential savings of up to 17 million pound sterling could be made each year if guidelines were followed more closely. There is a need for further research into SMBG use in patients with type 2 diabetes.
Belsey
J D
JD
JB Medical Limited, Sudbury, Suffolk, UK. jbelsey@jbmedical.com
Pittard
J B
JB
Rao
S
S
Urdahl
H
H
Jameson
K
K
Dixon
T
T
D015190:Blood Glucose Self-Monitoring / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000191:economics* / Q000628:therapy; D004032:Diet; D004359:Drug Therapy, Combination; D015444:Exercise; D019983:Guideline Adherence; D005102:Health Expenditures; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D008687:Metformin / Q000191:economics* / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics*; D045162:Thiazolidinediones / Q000191:economics* / Q000627:therapeutic use; D006113:United Kingdom
D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D008687:Metformin