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Tuesday 31 March 2015

Reduction in self-monitoring of blood glucose in type 2 diabetes: an observational controlled study in east London


Background Self-monitoring of blood glucose (SMBG) confers no benefit for many people with type 2 diabetes not being treated with insulin. It accounts for 21% of diabetes prescribing costs.

Aim To improve care quality at reduced cost for type 2 diabetes by reducing unnecessary SMBG.

Design and setting Non-randomised, observational controlled study in two intervention clinical commissioning groups (CCGs) and one control CCG in east London.

Method In total, 19 602 people with type 2 diabetes not being treated with insulin were recruited from two intervention CCGs; 16 033 were recruited from a control CCG. The intervention (from 2010 to 2013) comprised implementation of a locally developed guideline, including IT support and peer feedback of performance. Data on practice prescribing SMBG testing strips were gathered using GP electronic health records. Information on costs were obtained via the ePACT electronic database.

Results Over 4 years, in all non-insulin type 2 diabetes treatment groups, use of SMBG was reduced in the two intervention CCGs from 42.8% to 16.5%, and in the control CCG from 56.4% to 47.2%. In people on metformin alone or no treatment, intervention CCGs reduced SMBG use from 29.6% to 6.0%, and in the control CCG use dropped from 47.1% to 38.7% (P<0.001). From 2009 to 2012 the total cost of all SMBG prescribing (type 1 and type 2 diabetes, including users of insulin) was reduced by 4.9% (£62 476) in the two intervention CCGs and increased in the control CCG by 5.0% (£42 607); in England, the total cost increased by 13.5% (£19.4 million). In total, 20% (3865 of 19 602) fewer patients used SMBG in the intervention CCGs.

Conclusion This low-cost programme demonstrated a major reduction in unnecessary prescribing of SMBG, along with cost savings. If replicated nationally, this would avoid unnecessary testing in 340 000 people and prescribing costs that total £21.8 million.

Full text here:



Unknown said...

What a joke! I wonder how these "savings" will stack up over the long term increase in complications?

Mrs Vimes said...

Sorry but WTF! Give it a couple of years and like Indy Jill says costs will increase.

Anonymous said...

This is absolute bonkers. The study is essentially saying; this costs money, we are investigating whether doing less of it costs less money. The conclusion? It does! Wow! Money well spent study people.


This will get waved in the face of Type 2's as proof of something else entirely.

Note how that it does not appear to address at all the core assertion that "(SMBG) confers no benefit for many people with type 2 diabetes". What bollocks that is; it's patently untrue. If and here's the million dollar 'if' if you know what to do about the results and can free yourself from the things causing the high blood sugar.

From reading the link there is no suggestion at all that HbA1c was even measured. So how can they test that?

Additionally, of course, as it is NHS policy to keep to the low-fat high carb diet the diet these people would have been advised to stick to would be just that; the good old NHS diet of death and guess what? Even with blood testing if you are eating 100's of carbs a day things aren't going to get better.

What an outrageous piece of idiocy this is.

We are on our own here when this type of rubbish gets any attention.


Anonymous said...

This study is an example of bureaucratic logic. It is like studying how much money can be saved by eliminating maps or GPS. Then they wait for enough cars to drive off a cliff before making the new proposal that maps or GPS could be a cost effective way to lower costs.
Both ways, it proves the benefits of bureaucratic improvement.
The means justify the means.
From the Peoples Republic of Vermont.