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PAPERS: Alastair Gray, Philip Clarke, Andrew Farmer, and Rury Holman Implementing intensive control of blood glucose concentration and blood pressure in type 2 diabetes in England: cost analysis (UKPDS 63) BMJ 2002; 325: 860 [Abstract] [Full text]

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Solomon Grundy Blood Glucose Testing

David Kerr   (21 October 2002)

Solomon Grundy Blood Glucose Testing

David Kerr   (23 October 2002)

Solomon Grundy Blood Glucose Testing 21 October 2002
David Kerr, Consultant Bournemouth Diabetes and Endocrine Centre Send response to journal: Re: Solomon Grundy Blood Glucose Testing	Sir, So it appears that the single biggest cost of implementing intensive control of blood glucose levels in type 2 diabetes relates to the use of home blood glucose monitoring. This is surprising as a. At present there is a lack of evidence and agreement on the role of HMBG in type 2 diabetes. b. For newly diagnosed patients, there is no particular advantage to HBGM compared to urine testing (1). c. Actual usage of blood glucose strips by patients is much less than the reality of the situation (2). d. There are suggestions of an inverse relationship between the frequency of blood testing in type 2 diabetes and achieved HBA1c levels (3). In Bournemouth, for patients with type 2 diabetes in whom HBGM is indicated (e.g. those with altered renal threshold for glucose, those at risk of hypoglycaemia and those who prefer blood testing) we have adopted a novel approach. The patients test a fasting value on a Wednesday. If above ideal (for the individual), they test again on the Thursday and if still above ideal again on Friday. If the value is still above ideal, patients are taught to self-titrate their dose of oral agent and the cycle is repeated until agreed levels are achieved. In a pilot study this appears to work and is acceptable for patients (4). Using this approach togther with ruine testing, the costs of monitoring may be less than anticipated. The worst scenario occurs when patients test at unstructured times and no-one does anything with the information. Worse still if no-one bothers to even look at the results. References 1. Miles P, Everett J, Murphy J and Kerr D. Choice of blood or urine testing by patients with newly diagnosed non-insulin dependent diabetes. BMJ 1997: 315; 348-349. 2. Evans JM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ, Morris AD.Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database.BMJ 1999 Jul 10;319(7202):83-6. 3. Pellegrini FM et al. The impact of blood glucose self-monitoring on metabolic control and qquality of life in type 2 diabetic patients: an urgent need for better educational strategies. Diabetes Care 2001; 24: 1870-7. 4. Ingleby J, Trowbrudge S, Cavan D and Kerr D. Good control on one blood test a week. Diabetic Medicine 2002; 19(Suppl 2): 75.
Solomon Grundy Blood Glucose Testing 23 October 2002
David Kerr, Consultant Bournemouth Diabetes and Endocrine Centre BH7 7DL Send response to journal: Re: Solomon Grundy Blood Glucose Testing	Sir, So it appears that the single biggest cost of implementing intensive control of blood glucose levels in type 2 diabetes relates to the use of home blood glucose monitoring. This is surprising as a. At present there is a lack of evidence and agreement on the role of HMBG in type 2 diabetes. b. For newly diagnosed patients, there is no particular advantage to HBGM compared to urine testing (1). c. Actual usage of blood glucose strips by patients is much less than the reality of the situation (2). d. There are suggestions of an inverse relationship between the frequency of blood testing in type 2 diabetes and achieved HBA1c levels (3). In Bournemouth, for patients with type 2 diabetes in whom HBGM is indicated (e.g. those with altered renal threshold for glucose, those at risk of hypoglycaemia and those who prefer blood testing) we have adopted a novel approach. The patients test a fasting value on a Wednesday. If above ideal (for the individual), they test again on the Thursday and if still above ideal again on Friday. If the value is still above ideal, patients are taught to self-titrate their dose of oral agent and the cycle is repeated until agreed levels are achieved. In a pilot study this appears to work and is acceptable for patients (4). Using this approach together with urine testing, the costs of monitoring may be less than anticipated. The worst scenario occurs when patients test at unstructured times and no-one does anything with the information. Worse still if no-one bothers to even look at the results. References 1. Miles P, Everett J, Murphy J and Kerr D. Choice of blood or urine testing by patients with newly diagnosed non-insulin dependent diabetes. BMJ 1997: 315; 348-349. 2. Evans JM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ, Morris AD.Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database.BMJ 1999 Jul 10;319(7202):83-6. 3. Pellegrini FM et al. The impact of blood glucose self-monitoring on metabolic control and qquality of life in type 2 diabetic patients: an urgent need for better educational strategies. Diabetes Care 2001; 24: 1870-7. 4. Ingleby J, Trowbrudge S, Cavan D and Kerr D. Good control on one blood test a week. Diabetic Medicine 2002; 19(Suppl 2): 75.