BMJ 2015;350:h1715 doi: 10.1136/bmj.h1715 (Published 31 March 2015)
Page 1 of 1
Research News
RESEARCH NEWS Simple education reduces inappropriate blood glucose self monitoring in type 2 diabetes, study shows Susan Mayor London
A simple education and patient review programme for GPs reduced the proportion of patients with type 2 diabetes not treated with insulin who were inappropriately self monitoring their blood glucose by 20% over four years, a UK general practice study has shown.1
Many patients currently have routine blood glucose testing prescribed, and the number is increasing despite a lack of evidence that it improves glycaemic control or hypoglycaemia. So researchers investigated whether introducing local guidelines for GPs recommending individual patient review and information for patients could reduce the inappropriate use of glucose self monitoring.
The study, reported in the British Journal of General Practice, recruited 19 602 patients with type 2 diabetes not treated with insulin who were registered at practices in two clinical commissioning groups (CCGs) in east London (Tower Hamlets, and City and Hackney). A further 16 033 patients in Newham acted as controls. The researchers developed guidelines with local GPs, hospital consultants, specialist diabetes nurses, prescribing advisers, and patients on the use of self monitoring of blood glucose for type 2 diabetes not treated with insulin. They recommended case by case review of self testing in individual patients, taking into account the relative risks and benefits of testing in relation to the risks of hypoglycaemia and glycaemic control. The guidelines were disseminated to all practices taking part in the study, along with educational meetings to explain the recommendations. IT support was provided to help practices carry out computer searches to identify patients for review. Each practice was audited on its prescribing of self monitoring of
blood glucose at baseline and four years later, and results were fed back to GPs.
Results showed that the use of self monitoring fell from 42.8% of patients at baseline in 2009 to 16.5% in 2013, after three years of the intervention programme. By contrast, only a small reduction was seen in the control group over this time, from 56.4% at the start of the study to 47.2% at the end.
The total cost of all prescribing for self monitoring (for type 1 and type 2 diabetes patients, including those on insulin) was reduced by 4.9% (£62 476) in the two intervention CCGs from 2009 to 2012, while it increased by 5.0% (£42 607) in the control CCG. Overall, results showed that 20% fewer patients (3865 of 19 602) in the practices taking part in the intervention used self monitoring of blood glucose over the four years of the study. If replicated nationally, this programme would avoid unnecessary testing in 340 000 people and save prescribing costs totalling £21.8m (€29.9m; $32.5m), said the researchers.
1
Robson J, Smithers H, Chowdhury T, et al. Reduction in self monitoring of blood glucose in type 2 diabetes: an observational controlled study in east London. Br J Gen Pract 2015; doi:10.3399/bjgp15X684421.
Cite this as: BMJ 2015;350:h1715 © BMJ Publishing Group Ltd 2015
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Research News
RESEARCH NEWS Simple education reduces inappropriate blood glucose self monitoring in type 2 diabetes, study shows Susan Mayor London
A simple education and patient review programme for GPs reduced the proportion of patients with type 2 diabetes not treated with insulin who were inappropriately self monitoring their blood glucose by 20% over four years, a UK general practice study has shown.1
Many patients currently have routine blood glucose testing prescribed, and the number is increasing despite a lack of evidence that it improves glycaemic control or hypoglycaemia. So researchers investigated whether introducing local guidelines for GPs recommending individual patient review and information for patients could reduce the inappropriate use of glucose self monitoring.
The study, reported in the British Journal of General Practice, recruited 19 602 patients with type 2 diabetes not treated with insulin who were registered at practices in two clinical commissioning groups (CCGs) in east London (Tower Hamlets, and City and Hackney). A further 16 033 patients in Newham acted as controls. The researchers developed guidelines with local GPs, hospital consultants, specialist diabetes nurses, prescribing advisers, and patients on the use of self monitoring of blood glucose for type 2 diabetes not treated with insulin. They recommended case by case review of self testing in individual patients, taking into account the relative risks and benefits of testing in relation to the risks of hypoglycaemia and glycaemic control. The guidelines were disseminated to all practices taking part in the study, along with educational meetings to explain the recommendations. IT support was provided to help practices carry out computer searches to identify patients for review. Each practice was audited on its prescribing of self monitoring of
blood glucose at baseline and four years later, and results were fed back to GPs.
Results showed that the use of self monitoring fell from 42.8% of patients at baseline in 2009 to 16.5% in 2013, after three years of the intervention programme. By contrast, only a small reduction was seen in the control group over this time, from 56.4% at the start of the study to 47.2% at the end.
The total cost of all prescribing for self monitoring (for type 1 and type 2 diabetes patients, including those on insulin) was reduced by 4.9% (£62 476) in the two intervention CCGs from 2009 to 2012, while it increased by 5.0% (£42 607) in the control CCG. Overall, results showed that 20% fewer patients (3865 of 19 602) in the practices taking part in the intervention used self monitoring of blood glucose over the four years of the study. If replicated nationally, this programme would avoid unnecessary testing in 340 000 people and save prescribing costs totalling £21.8m (€29.9m; $32.5m), said the researchers.
1
Robson J, Smithers H, Chowdhury T, et al. Reduction in self monitoring of blood glucose in type 2 diabetes: an observational controlled study in east London. Br J Gen Pract 2015; doi:10.3399/bjgp15X684421.
Cite this as: BMJ 2015;350:h1715 © BMJ Publishing Group Ltd 2015
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
