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Glucose self monitoring in the UK

Study
Results
Comment

With new technologies, we need not only to know how good they are, and how people value them, we also need to know where we are now, and what the dynamics are. When it comes to glucose self monitoring in primary care in the UK, a study [1] at least tells us what was happening up to 1998.

Study

This is an analysis of the UK General Practice Research Database (GPRD), with large amounts of good data on primary care in the UK. The cohort of subjects was first prescribed oral hypoglycaemic drugs between 1993 and 1998, dates chosen to optimise the number of practices and duration of follow up. Subjects aged less than 30 years, and with less than three months of follow up were excluded.

Information was collected for the first year after the first prescription of oral hypoglycaemic drugs, with censoring if patients died or were changed to insulin. The number of prescriptions for glucose monitoring strips during the first year was the main outcome.

Results

Over the six years and 263 practices, 11,688 subjects were first prescribed oral hypoglycaemic drugs. The average age was 64 years, and half were women. The number of subjects per practice averaged 45, ranging from four to 142.

Overall, 28% had no monitoring prescribed, with 36% prescribed urine monitoring, 25% blood monitoring, and 11% urine and blood monitoring. Over the period the trend was for blood monitoring to increase and urine monitoring to decrease, with blood monitoring being more common than urine by the end of the period (Figure 1). The proportion who did not monitor increased from 24% in 1993 to about 30% over later years.



Figure 1: UK monitoring 1993-1998





Age was a major factor in monitoring. The proportion not monitoring increased from about 25% in the under-75 population, to 38% in those aged 75-84 years, and to 53% in those aged over 85 years. Blood monitoring was more frequently used in younger patients (Figure 2).



Figure 2: UK monitoring by age group





There was wide variation between practices over their monitoring policy. For urine monitoring the range was 0 to 95% of patients using urine monitoring, and for blood monitoring it was 6-91%. There was also very considerable geographical variation within the UK, with blood monitoring highest in Wales (42%), urine monitoring highest in Scotland (Figure 3), and patients in Northern Ireland having the highest proportion (61%) not monitoring.



Figure 3: UK monitoring by region





Comment

Of course, this information is now almost a decade out of date, but it demonstrates the uncertainty that has existed until recently about the value of any glucose self monitoring in type 2 diabetes, and if there is benefit, which type should be used. We now have better information. We can be pretty sure that blood glucose self monitoring reduces glycated haemoglobin levels, at least in a majority of patients with type 2 diabetes. Better control leads to fewer complications and lower treatment costs. We also have strong indications that patients are not happy with urine monitoring. The evidence for using blood glucose self monitoring in people with type 2 diabetes appears to be growing.

Reference:

  1. M Gulliford, R Latinovic. Variations in glucose self-monitoring during oral hypoglycaemic therapy in primary care. Diabetes Medicine 2004 21: 685-690.

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