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Diabetes self-tests a waste of NHS resources April 19, 2008

Posted by grhomeboy in Health.
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Encouraging people with type 2 diabetes to monitor their own blood sugar levels may not improve care and is a waste of NHS resources, two studies suggest according to a recent BBC report.

One group of researchers found patients who self-test are more likely to end up depressed than in better health. Another found self-testing costs £90 extra per patient per year and may lead to worse quality of life, the British Medical Journal reported. But the government said for some people self-monitoring could be very useful. Being able to monitor blood sugar levels is very helpful for patients who need to take insulin to control their diabetes.

In recent years there has also been a big push to encourage self-testing in diabetic patients not treated with insulin. There are 2.35m people with diabetes in the UK, the vast majority of whom have type 2 diabetes where the body does not produce enough insulin or the insulin that is produced does not work properly.

A trial of 180 people newly diagnosed with type 2 diabetes in Northern Ireland found self-monitoring did not improve blood glucose control compared with normal care. And those who self-monitored had a 6% higher score for depression. Study leader Dr Maurice O’Kane said: “What we can say is if people do not want to monitor there’s no evidence their care will be inferior.” NHS funding of test strips increased from £85m to £118m between 2001 and 2003.

University of Oxford researchers looked at the cost-effectiveness of self-monitoring in type 2 diabetes on top of usual care, using results from a trial of 450 patients published last year. They found self-monitoring of blood glucose is significantly more expensive and associated with a lower quality of life, probably due to increased levels of anxiety and depression. Study leader Dr Judit Simon said: “The current study shows routine self-monitoring is not cost-effective and there is a negative effect on quality of life for some people.”

Libby Dowling, care advisor at Diabetes UK, said decisions on self-monitoring must be made on an individual basis and patients must be educated on what to do with the results. “Poorly controlled diabetes can increase the risk of complications such as heart disease, blindness and stroke, so short-term cost savings made by reducing the number of people self-monitoring could be dangerous for the individual and lead to higher costs for the NHS in the long term.”

A spokesman for the Department of Health said: “NICE guidelines state that for some people self-monitoring can be useful in their overall approach to self-care. “However, self-monitoring cannot be looked at in isolation and in order to obtain maximum benefit people with diabetes need to access to the right education and support to understand what the results mean for them personally.”

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