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

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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

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Blood Glucose Self-Monitoring
Cost Savings
Type 2 Diabetes Mellitus
chronic illness
savings
Hemoglobins
monitoring
human being
costs
Guidelines
Diet Therapy
Veterans
Diet
Costs and Cost Analysis
Hypoglycemic Agents
regression analysis

ASJC Scopus subject areas

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

Cite this

Reduction in self-monitoring of blood glucose in persons with type 2 diabetes results in cost savings and no change in glycemic control. / Meier, Joy L.; Swislocki, Arthur L; Lopez, Julio R.; Noth, Robert H.; Bartlebaugh, Patricia; Siegel, David.

In: American Journal of Managed Care, Vol. 8, No. 6, 2002, p. 557-565.

Research output: Contribution to journalArticle

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T1 - Reduction in self-monitoring of blood glucose in persons with type 2 diabetes results in cost savings and no change in glycemic control

AU - Meier, Joy L.

AU - Swislocki, Arthur L

AU - Lopez, Julio R.

AU - Noth, Robert H.

AU - Bartlebaugh, Patricia

AU - Siegel, David

PY - 2002

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N2 - 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.

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