Monday, August 6, 2018

Self-Monitoring Saves Money in Finland

"Physicians continue to recommend routine self-monitoring of blood glucose for patients with non-insulin treated type 2 diabetes, in spite of its lack of effectiveness (italics added), because they believe it drives the lifestyle changes needed to improve glycemic control." This is from a recent press release from the American Academy of Family Physicians.

This suggests that the "lack of effectiveness" is a fact, not their opinion, despite the fact that they go on to say that there are both proponents and opponents of self-monitoring of blood glucose (SMBG).

I've discussed this before here  and here. Basically, SMBG does little good if patients are given a meter and told to test once a day, usually fasting or if they're told to test more often, usually before meals but not after eating but they're not told what to do with the results.

 Motivated patients have used their meters to determine which foods make their blood glucose (BG) levels increase the most, and they then eliminate these foods or greatly reduce their consumption. When they do, they find great improvement in their measures of control such as the hemoglobin A1c test. However, such success stories are annecdotal, not formal studies.

One common criticism of SMBG is the cost. Thus it is encouraging to see a Finnish study showing that SMBG along with an electronic feedback system reduced total costs by almost 60%. The study was done in a rural area, and the researchers said that reducing travel costs contributed about 20% to the total savings. So the combination of SMBG and electronic feedback reduced total costs about 40%.

The travel costs are the focus of this article, so there's no discusion of the SMBG or the electronic feedback. Nevertheless, it's encouraging to see that some health care systems recognize the importance of SMBG in treating people with type 2 diabetes.

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