Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial
Open accessAbstract
OBJECTIVE: To assess the cost effectiveness of self monitoring of blood glucose alone or with additional training in incorporating the results into self care, in addition to standardised usual care for patients with non-insulin treated type 2 diabetes. DESIGN: Incremental cost utility analysis from a healthcare perspective. Data on resource use from the randomised controlled diabetes glycaemic education and monitoring (DiGEM) trial covered 12 months before baseline and 12 months of trial follow-up. Quality of life was measured at baseline and 12 months using the EuroQol EQ-5D questionnaire. SETTING: Primary care in the United Kingdom. PARTICIPANTS: 453 patients with non-insulin treated type 2 diabetes. INTERVENTIONS: Standardised usual care (control) compared with additional self monitoring of blood glucose alone (less intensive self monitoring) or with training in self interpretation of the results (more intensive self monitoring). MAIN OUTCOME MEASURES: Quality adjusted life years and healthcare costs (sterling in 2005-6 prices). RESULTS: The average costs of intervention were pound89 (euro113; $179) for standardised usual care, pound181 for less intensive self monitoring, and pound173 for more intensive self monitoring, showing an additional cost per patient of pound92 (95% confidence interval pound80 to pound103) in the less intensive group and pound84 ( pound73 to pound96) in the more intensive group. No other significant cost difference was detected between the groups. An initial negative impact of self monitoring on quality of life occurred, averaging -0.027 (95% confidence interval-0.069 to 0.015) for the less intensive self monitoring group and -0.075 (-0.119 to -0.031) for the more intensive group. CONCLUSIONS: Self monitoring of blood glucose with or without additional training in incorporating the results into self care was associated with higher costs and lower quality of life in patients with non-insulin treated type 2 diabetes. In light of this, and no clinically significant differences in other outcomes, self monitoring of blood glucose is unlikely to be cost effective in addition to standardised usual care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN47464659.
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SMBG is not cost-effective in people with non-insulin-treated type 2 diabetes.
“Furthermore, SMBG is not cost-effective in people with non-insulin-treated type 2 diabetes (20).”
From The impact of structured self-monitoring of blood glucose on clinical, behavioral, and psychosocial outcomes among adults with non-insulin-treated type 2 diabetes: a systematic review and meta-analysis (2023) · cites this paper as [20]
The Discussion says neither form of SMBG is likely to be cost-effective when added to standardised usual care for reasonably well-controlled patients with non-insulin-treated type 2 diabetes. The citing sentence states this categorically for all such patients, whereas the paper cautions that results may differ in specific groups or other care settings (Discussion; Implications for clinicians and policymakers). (LLM, conf=0.88)
Experimental — accuracy not yet measuredExcept for the potential use of BGM in people with type 2 diabetes using insulin, BGM likely adds cost without benefit.
“However, except for the potential use of BGM in people with type 2 diabetes using insulin, BGM likely adds cost without benefit (110).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [110]
The Abstract and Discussion (page not available in our copy) report higher costs and no clinically significant benefit from self-monitoring compared with standardised usual care. But the study concerns reasonably well-controlled people with non-insulin-treated type 2 diabetes; the Discussion cautions that its results may not apply to other groups. It does not establish the claim for everyone except those using insulin. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe DiGEM study identified a small, significant between-group difference in health status (EQ-5D).
“The DiGEM study identified a small, significant between-group difference in health status (EQ-5D) (20).”
A cost-effectiveness analysis of DiGEM data concluded SMBG is unlikely to be cost-effective in addition to standardised usual care for non-insulin-treated type 2 diabetes.
“self monitoring of blood glucose is unlikely to be cost effective in addition to standardised usual care”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [108]
Several recent trials have called into question the clinical utility and cost-effectiveness of routine SMBG in non-insulin-treated patients.
“Several recent trials have called into question the clinical utility and cost-effectiveness of routine SMBG in non–insulin-treated patients (34–36).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [36]
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- Authors
- Simon, J., Gray, A., Clarke, P., Wade, A., Neil, A., & Farmer, A.
- Affiliations
- University of Oxford (GB)
- The University of Sydney (AU)
- Johns Hopkins University (US)
- Corresponding author
- Simon, Judit
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2008-04-17
- Volume
- 336
- Issue
- 7654
- Pages
- 1177-1180
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2394644
- OpenAlex
- W2021612182
- Semantic Scholar
- 2fa789a09f2e7d16f120b5928015ef968d2f1a95
- Cited by
- 206
- References
- 21
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 6 · 2022: 12 · 2021: 6 · 2020: 6 · 2019: 8 · 2018: 7 · 2017: 9 · 2016: 10 · 2015: 8 · 2014: 12 · 2013: 22 · 2012: 14
- FWCI
- 57.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- self-monitoring of blood glucose, type 2 diabetes, non-insulin-treated diabetes, cost-effectiveness, patient education, quality of life, health care costs, quality-adjusted life years, primary care
- MeSH terms
- Adult, Aged, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Male, Middle Aged, Prognosis, Prospective Studies, Quality of Life, Blood Glucose Self-Monitoring, Quality-Adjusted Life Years
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