title: Self-monitoring of blood glucose: guideline application rather than utilization restrictions on testing strips has potential to reduce diabetes healthcare costs in Italy.
abstract: BACKGROUND
  Self-monitoring of blood glucose (SMBG) is a proven tool to improve glycemic control, even if it might increase direct costs for diabetes management. In Italy, the purchase, prescription rules and responsibilities, and distribution of testing strips per type of patient are managed differently in each of the 20 Italian regions. The Italian scientific societies for diabetes (Società Italiana Diabetologia [SID] and Associazione Medici Diabetologi [AMD]) have issued validated guidelines for SMBG, but not all regions apply them. We investigated whether following SID-AMD guidelines would help decreasing SMBG and diabetes healthcare costs in Italy.
  
  
  METHODS
  We compared the regions applying and not applying SMBG guidelines for the mean number of testing strips used, number of hospitalizations (with the principal diagnosis of diabetes, excluding diabetes complications), and duration of hospitalization, as indirect measures of SMBG cost.
  
  
  RESULTS
  Regions applying the guidelines recorded higher SMBG testing strip utilization than regions not applying guidelines, but they recorded fewer hospitalizations for diabetes (36.2 ± 11.3 vs. 79.9 ± 27.8 hospitalizations per 100,000 inhabitants, P<0.002) and fewer days in the hospital (363 ± 106 vs. 685 ± 194 days of hospitalization for diabetes per 100,000 inhabitants, P<0.002).
  
  
  CONCLUSIONS
  Our data suggest that application of guidelines for SMBG prescription and a strict cooperation between health providers and regional health economic deciders were associated with greater utilization of SMBG testing strips. They were also associated with significantly reduced number of hospitalizations and reduced overall duration of hospitalization for patients with diabetes, potentially saving healthcare costs.
authors.affiliation: Università Cattolica del Sacro Cuore, Rome, Italy. giaccari@rm.unicatt.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Giaccari
authors.forename: Giorgio
authors.initials: G
authors.lastname: Grassi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ozzello
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000191:economics; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000191:economics / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000191:economics / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D017410:Practice Guidelines as Topic; D011934:Reagent Strips / Q000191:economics / Q000600:supply & distribution
chemical_list: D001786:Blood Glucose; D011934:Reagent Strips