Studies question £100 million/year spent on diabetes self-monitoring


Studies question £100 million/year spent on diabetes self-monitoring


According to two studies published on bmj.com, the UK's National Health Service (NHS) spends £100 million each year to assist people with non-insulin treated type 2 diabetes control their own blood sugar levels. However, rather than providing long-term health benefits, the process increases a patient's likelihood of becoming depressed and anxious.

One in every twenty people around the world suffers from diabetes. Most of these (85-95%) have type 2 diabetes - also commonly known as adult-onset diabetes. Type 2 diabetes occurs when insulin production in the body has stopped or the body cannot produce enough insulin to convert blood sugar into energy for bodily functions. In the UK, the incidence of type 2 diabetes has been increasing.

There is consensus in the medical community that patients who have type 1 diabetes have generally positive outcomes when they self-monitor blood glucose levels. Benefits have also been seen in type 2 diabetes patients who treat their condition with insulin. Most type 2 suffers, however, do not treat themselves with insulin, and the medical community is not necessarily in agreement that self-monitoring of blood sugar levels is effective for this subgroup. In clinical situations - even though there is not a lot of evidence to support self-monitoring - there has been strong encouragement for this group to self-monitor.

To investigate the links between self-monitoring, blood glucose levels, and the incidence of hypoglycemia (when below-normal blood sugar levels affect brain function) in people who have been newly diagnosed with type 2 diabetes, Dr Maurice O'Kane (University of Ulster) and colleagues conducted a randomized, controlled trial. Their primary conclusion was that blood sugar levels and cases of hypoglycemia after one year were not significantly affected by self-monitoring. Participants in the self-monitoring group did, however, report higher levels of depression and anxiety than those in the control group.

"Anecdotal and other evidence suggests that some patients consider [self] monitoring uncomfortable, intrusive, and unpleasant," write the authors. The researchers also suggest that, "The negative effect might relate less to feelings

of powerlessness in the face of high blood glucose readings than to the enforced discipline of regular monitoring without any tangible gain."

Between 2001 and 2003, the UK has increased spending on test strips from £85m to £118m, making self-monitoring of blood glucose the greatest single management cost associated with putting into effect more intensive blood glucose control. These statistics have led researchers to ask if self-monitoring is in fact cost-effective and if there are other aspects of diabetes care that these funds could finance that would be more cost-effective.

A cost-effectiveness analysis,

Simon and colleagues found that compared to standardized usual care, self-monitoring of blood glucose levels is significantly more costly. There was an additional yearly cost of £90 for each patient who self-monitored. In addition, the researchers concluded that people who self monitor reported having a lower quality of life, most likely due to significant increases in anxiety and depression.

Since self-monitoring in addition to standardized usual care is not expected to yield any significant lifetime health benefits or be cost-effective for the NHS, the authors conclude that, "This study therefore provides no convincing evidence for routinely recommending self monitoring to patients with non-insulin treated type 2 diabetes."

An editorial accompanying the two articles is blood pressure, cholesterol, smoking, body weight, and physical activity."

Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial

Judit Simon, Alastair Gray, Philip Clarke, Alisha Wade, Andrew Neil, Andrew Farmer, on behalf of the Diabetes Glycaemic Education and Monitoring Trial Group

BMJ. (April 2008)

doi:10.1136/bmj.39526.674873.BE

Click Here to See Article Online

Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial

Maurice J O'Kane, Brendan Bunting, Margaret Copeland, Vivien E Coates, on behalf of the ESMON study group

BMJ. (April 2008)

doi:10.1136/bmj.39534.571644.BE

Click Here to See Article Online


Tackling diabetes with a bold new dietary approach: Neal Barnard at TEDxFremont (Video Medical And Professional 2018).

Section Issues On Medicine: Medical practice