Reduction in self-monitoring of blood glucose in persons with type 2 diabetes results in cost savings and no change in glycemic control

Joy L. Meier, Arthur L Swislocki, Julio R. Lopez, Robert H. Noth, Patricia Bartlebaugh, David Siegel

Research output: Contribution to journalArticle

47 Scopus citations

Abstract

Objective: Recent Veterans Affairs (VA) guidelines recommend that persons with stable type 2 diabetes controlled on oral agents or diet therapy perform self-monitoring of blood glucose (SMBG) twice weekly. We assessed the impact of a modification of these guidelines on hemoglobin A1c (HbA1c) and monitoring cost. Study design: Retrospective, noncrossover clinical trial. Patients and methods: We instructed persons with type 2 diabetes to perform SMBG testing according to modified adapted VA guidelines. We compared patients' baseline average testing frequency and HbA1c with those obtained during a 6-month interval beginning 2 months after implementation of the modified guidelines. The impact on the cost of monitoring was calculated. Results: At baseline, 913 of 1213 SMBG users with diabetes on oral hypoglycemic agents had HbA1c tested (HbA1c=7.83% ± 1.34%); their frequency of SMBG was 1.36 ± 0.95 strips per patient per day. Postimplementation, 974 of 1278 persons with diabetes had HbA1c tested (HbA1c = 7.86% ± 1.54%; P = .63 vs baseline); frequency of SMBG decreased by 46% to 0.74 ± 0.50 strips per patient per day (P < .0001). At baseline, 154 of 254 SMBG users with diabetes on diet therapy had HbA1c tested (HbA1c = 6.85% ± 0.97%); their frequency of SMBG was 1.07 ± 0.90 strips per patient per day. Postimplementation, 177 of 282 diet-treated persons with diabetes had HbA1c tested (HbA1c = 6.78% ± 1.20%; P = .56 vs baseline); frequency of SMBG decreased by 35% to 0.70 ± 0.51 strips per patient per day (P < .0001). Similar findings were observed in a cohort of 421 drug-treated patients with paired HbA1c data before and after implementation, and a cohort of 50 diet-treated patients with paired HbA1c data. Linear regression analysis showed no significant impact on individuals' HbA1c with reduction in strip use. Average monthly cost savings were $8800, or $6.37 per patient per month. Conclusions: This program decreased the frequency of SMBG in persons with type 2 diabetes, resulting in substantial cost savings without affecting glucose control.

Original languageEnglish (US)
Pages (from-to)557-565
Number of pages9
JournalAmerican Journal of Managed Care
Volume8
Issue number6
StatePublished - 2002
Externally publishedYes

ASJC Scopus subject areas

  • Nursing(all)
  • Medicine(all)
  • Health(social science)
  • Health Professions(all)

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