Editor—According to the paper by Gray et al, the single biggest cost of implementing intensive control of blood glucose concentrations in type 2 diabetes relates to the use of home blood glucose monitoring.1 This is surprising.
Firstly, currently evidence and agreement are lacking on the role of home blood glucose monitoring in type 2 diabetes.
Secondly, for newly diagnosed patients, home blood glucose monitoring does not offer any particular advantage compared with urine testing.2
Thirdly, actual usage of blood glucose strips by patients is much less than the reality of the situation.3
Fourthly, suggestions have been made of an inverse relation between the frequency of blood testing in type 2 diabetes and achieved concentrations of glycated haemoglobin.4
We have adopted a new approach in Bournemouth for patients with type 2 diabetes in whom home blood glucose monitoring is indicated (patients with altered renal threshold for glucose, those at risk of hypoglycaemia, and those who prefer blood testing). The patients test a fasting value on a Wednesday. If this is above the ideal value (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 concentrations are achieved. In a pilot study this seems to work and is acceptable for patients.5
When this approach is used 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.Gray A, Clarke P, Farmer A, Holman R. Implementing intensive control of blood glucose concentration and blood pressure in type 2 diabetes in England: cost analysis (UKPDS 63) BMJ. 2002;325:860–865. doi: 10.1136/bmj.325.7369.860. . (19 October.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Miles P, Everett J, Murphy J, Kerr D. Choice of blood or urine testing by patients with newly diagnosed non-insulin dependent diabetes. BMJ. 1997;315:348–349. doi: 10.1136/bmj.315.7104.348. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.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;319:83–86. doi: 10.1136/bmj.319.7202.83. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Franciosi M, Pellegrini F, De Berardis G, Belfiglio M, Cavaliere D, Di Nardo B, et al. The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies. Diabetes Care. 2001;24:1870–1877. doi: 10.2337/diacare.24.11.1870. [DOI] [PubMed] [Google Scholar]
- 5.Ingleby J, Trowbrudge S, Cavan D, Kerr D. Good control on one blood test a week. Diabet Med. 2002;19:75. [Google Scholar]