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No evidence for diabetes self-monitoring

By Nigel Praities

Millions of pounds are being wasted in recommending use of self-monitoring strips to patients with diabetes, a major new study concludes.

Self-monitoring of blood glucose is not cost-effective in patients who are treated without insulin and should not be recommended by GPs, reports the first economic analysis of data from a prospective clinical trial.

The research, published online by the BMJ, throws a huge question mark over advice in NICE draft guidance on diabetes, which sets out an important role for glucose self-monitoring.

Self-monitoring strips cost the NHS over £141 million a year in total. But the DiGEM study of 453 patients in primary care found their use in patients who did not need insulin was more expensive, made no difference to outcomes and initially had a damaging effect on quality of life when compared with standard care.

By contrast, NICE guidance on type 2 diabetes, currently out for consultation, says self-monitoring should be offered to newly diagnosed people with type 2 diabetes as an integral part of self-management education.

Study leader Dr Judit Simon, senior researcher at the University of Oxford, said although self-monitoring was beneficial for patients being treated with insulin, this study showed there was no convincing evidence in non-insulin treated patients.

‘There are people who maybe will find it helpful, but routinely, as recommended in clinical guidelines, it is not cost-effective or clinically effective,' she said.

A spokesperson from Diabetes UK disputed those conclusions, saying the decision to prescribe self-monitoring must be made on an ‘individual basis'.

‘For many, self-monitoring informs the daily adjustments needed to effectively control diabetes,' she said.

But the research seems to have hardened criticism of NICE's position on self-monitoring. Dr Azhar Farooqi, a GP in Leicester and member of the Primary Care Diabetes Society, said the study showed GPs were over prescribing self-monitoring devices for patients with type 2 diabetes.

‘This reinforces that if patients are not on insulin, or at risk of hypoglycaemia from other agents, then we have got to be very careful about advising patients to self-monitor. It has got to be linked with some change in behaviour,' he said.

An editorial in the BMJ by Professor Martin Gulliford, professor of public health at King's College London, said the research showed self-monitoring for patients with type 2 diabetes carried an ‘opportunity cost' in terms of reducing the resources GPs had for measures such as reducing cholesterol level, blood pressure control and increasing physical activity.

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