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Blood glucose self checks waste of money

£100 million NHS spends on self monitoring better spent on other diabetes care, say researchers

Caroline White

Friday, 18 April 2008

The £100 million the NHS forks out every year to help diabetics monitor their own blood sugar is a waste of money and unlikely to confer any health benefits, suggest the results of two studies published in the BMJ online.

If anything it is more likely to depress patients than provide any long term health benefits, conclude the researchers.

Self monitoring does help patients with type 1 diabetes and those type 2 diabetics who use insulin to control their condition, say the authors.

But most people with type 2 diabetes do not use insulin, and there is no evidence to suggest that self monitoring works in this group. Yet the technique is widely promoted in clinical practice.

University of Ulster researchers carried out a randomised controlled trial to assess the impact of self monitoring on the incidence of hypoglycaemia in people newly diagnosed with type 2 diabetes, and found that it had made no difference after a year.

But the patients in the self-monitoring group had higher levels of depression and anxiey.

This prompted the authors to suggest that the enforced discipline of regular monitoring without any obvious benefit, rather than “feelings of powerlessness in the face of high blood glucose readings,” might be to blame.

In a separate study, from the University of Oxford, researchers analysed the cost effectiveness of helping patients with non-insulin type 2 diabetes monitor their own blood glucose levels in addition to standardised usual care, using data from the diabetes glycaemic education and monitoring (DiGEM) trial.

Their analysis confirmed that self monitoring of blood glucose was significantly more expensive than the standardised usual care.

The researchers found that self monitoring cost an additional £90 per head each year.

And those who checked their own blood glucose had poorer quality of life and were significantly more depressed and anxious than those who were not self monitoring.

“This study therefore provides no convincing evidence for routinely recommending self monitoring to patients with non-insulin treated type 2 diabetes,” they conclude.

Self monitoring of blood glucose is the most expensive component of intensive blood glucose control in the UK.

The costs of providing test strips rose from £85m to £118m between 2001 and 2003 alone, raising questions about whether the money could be put to better use to finance other aspects of diabetes care.

In an accompanying editorial, Professor Martin Gulliford, of King’s College, London, argues that the £100 m might be better spent on “more effective disease control measures aimed not at blood glucose but also at blood pressure, cholesterol, smoking, body weight, and physical activity.”

“For some people who control their type 2 diabetes without insulin, it may not be necessary to test their own blood glucose levels; however every person with diabetes is different so decisions must be made on an individual basis,” commented Libby Dowling, Care Advisor at Diabetes UK.

Those who checked their own blood glucose were also likely to be on more medication, have had type 2 diabetes for longer, and may already have serious complications, she said.

“Many people with diabetes are not sufficiently educated about self-monitoring. Any or all of these factors could lead to feelings of anxiousness and depression, but it is unlikely to be the actual self-monitoring alone that is the cause of them,” she added.

doi:10.1136/bmj.39534.571644.BE
doi:10.1136/bmj.39526.674873.BE
doi:10.1136/bmj.39538.469421.80

 

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