BMJ 1999;319:83-86 ( 10 July )

Papers

Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database

Josie M M Evans, Wellcome postdoctoral research fellow in health services research, a Ray W Newton, consultant diabetologist, b Danny A Ruta, senior lecturer, c Thomas M MacDonald, professor of pharmacoepidemiology, a Richard J Stevenson, medical student, d Andrew D Morris, senior lecturer. d

a Medicines Monitoring Unit, Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY, b Diabetes Centre, Ninewells Hospital and Medical School, c Department of Epidemiology and Public Health, Ninewells Hospital and Medical School, d Department of Medicine, Ninewells Hospital and Medical School

Correspondence to: J M M Evans josie{at}memo.dundee.ac.uk

Objectives: To investigate patterns of self monitoring of blood glucose concentration in diabetic patients who use insulin and to determine whether frequency of self monitoring is related to glycaemic control.
Setting: Diabetes database, Tayside, Scotland.
Subjects: Patients resident in Tayside in 1993-5 who were using insulin and were registered on the database and diagnosed with insulin dependent (type 1) or non-insulin dependent (type 2) diabetes before 1993.
Main outcome measures: Number of glucose monitoring reagent strips dispensed (reagent strip uptake) derived from records of prescriptions. First recorded haemoglobin A1c concentration in the study period, and reagent strips dispensed in the previous 6 months.
Results: Among 807 patients with type 1 diabetes, 128 (16%) did not redeem any prescriptions for glucose monitoring reagent strips in the 3 year study period. Only 161 (20%) redeemed prescriptions for enough reagent strips to test glucose daily. The corresponding figures for the 790 patients with type 2 diabetes who used insulin were 162 (21%; no strips) and 131 (17%; daily tests). Reagent strip uptake was influenced both by age and by deprivation category. There was a direct relation between uptake and glycaemic control for 258 patients (with recorded haemoglobin A1c concentrations) with type 1 diabetes. In a linear regression model the decrease in haemoglobin A1c concentration for every extra 180 reagent strips dispensed was 0.7%. For the 290 patients with type 2 diabetes who used insulin there was no such relation.
Conclusions: Self monitoring of blood glucose concentration is associated with improved glycaemic control in patients with type 1 diabetes. Regular self monitoring in patients with type 1 and type 2 diabetes is uncommon.


Key messages

  • Several studies have indicated the importance of self monitoring of blood glucose concentration for prevention of complications in patients with diabetes

  • Uptake of reagent strips for self monitoring of blood glucose among diabetic patients who used insulin was low, with only 20% of patients with type 1 diabetes and 17% of those with type 2 diabetes obtaining enough strips to test blood glucose concentration once daily

  • Reagent strip uptake depends on characteristics such as age and social deprivation category, and patient groups with low uptake should be identified and targeted

  • There was a direct association between strip uptake in the previous 6 months and glycaemic control in patients with type 1 diabetes but not in those with type 2 diabetes




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