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.
Rapid Response:
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.
Competing interests: No competing interests