Meier Joy L, Swislocki Arthur L M, Lopez Julio R, Noth Robert H, Bartlebaugh Patricia, Siegel David
Pharmacy Services, VA Northern California Health Care System, Martinez 94553, USA.
Am J Manag Care. 2002 Jun;8(6):557-65.
Recent Veterans Affairs (VA) guidelines recommend that persons with stable type 2 diabetes controlled on oral agents or diet therapy perform self-monitoring of blood glucose (SMBG) twice weekly. We assessed the impact of a modification of these guidelines on hemoglobin A1c (HbA1c) and monitoring cost.
Retrospective, noncrossover clinical trial.
We instructed persons with type 2 diabetes to perform SMBG testing according to modified adapted VA guidelines. We compared patients' baseline average testing frequency and HbA1c with those obtained during a 6-month interval beginning 2 months after implementation of the modified guidelines. The impact on the cost of monitoring was calculated.
At baseline, 913 of 1,213 SMBG users with diabetes on oral hypoglycemic agents had HbA1c tested (HbA1c = 7.83% +/- 1.34%); their frequency of SMBG was 1.36 +/- 0.95 strips per patient per day. Postimplementation, 974 of 1,278 persons with diabetes had HbA1c tested (HbA1c = 7.86% +/- 1.54%; P= .63 vs baseline); frequency of SMBG decreased by 46% to 0.74 +/- 0.50 strips per patient per day (P < .0001). At baseline, 154 of 254 SMBG users with diabetes on diet therapy had HbA1c tested (HbA1c = 6.85% +/- 0.97%); their frequency of SMBG was 1.07 +/- 0.90 strips per patient per day. Postimplementation, 177 of 282 diet-treated persons with diabetes had HbA1c tested (HbA1c = 6.78% +/- 1.20%; P = .56 vs baseline); frequency of SMBG decreased by 35% to 0.70 +/- 0.51 strips per patient per day (P < .0001). Similar findings were observed in a cohort of 421 drug-treated patients with paired HbA1c data before and after implementation, and a cohort of 50 diet-treated patients with paired HbA1c data. Linear regression analysis showed no significant impact on individuals' HbA1c with reduction in strip use. Average monthly cost savings were $8,800, or $6.37 per patient per month.
This program decreased the frequency of SMBG in persons with type 2 diabetes, resulting in substantial cost savings without affecting glucose control.
美国退伍军人事务部（VA）近期发布的指南建议，使用口服药物或饮食疗法控制稳定的2型糖尿病患者每周进行两次血糖自我监测（SMBG）。我们评估了这些指南的修改对糖化血红蛋白（HbA1c）和监测成本的影响。
回顾性、非交叉临床试验。
我们指导2型糖尿病患者按照修改后的VA指南进行SMBG检测。我们将患者的基线平均检测频率和HbA1c与修改后的指南实施2个月后开始的6个月期间所获得的数据进行比较。计算了对监测成本的影响。
基线时，1213名使用口服降糖药的糖尿病SMBG使用者中有913人进行了HbA1c检测（HbA1c = 7.83%±1.34%）；他们的SMBG频率为每位患者每天1.36±0.95条试纸。实施后，1278名糖尿病患者中有974人进行了HbA1c检测（HbA1c = 7.86%±1.54%；与基线相比P = 0.63）；SMBG频率下降了46%，至每位患者每天0.74±0.50条试纸（P < 0.0001）。基线时，254名接受饮食疗法的糖尿病SMBG使用者中有154人进行了HbA1c检测（HbA1c = 6.85%±0.97%）；他们的SMBG频率为每位患者每天1.07±0.90条试纸。实施后，282名接受饮食治疗的糖尿病患者中有177人进行了HbA1c检测（HbA1c = 6.78%±1.20%；与基线相比P = 0.56）；SMBG频率下降了35%，至每位患者每天0.70±0.51条试纸（P < 0.0001）。在一组有实施前后配对HbA1c数据的421名药物治疗患者以及一组有配对HbA1c数据的50名饮食治疗患者中也观察到了类似的结果。线性回归分析显示，试纸使用减少对个体的HbA1c没有显著影响。平均每月节省成本8800美元，即每位患者每月6.37美元。
该方案降低了2型糖尿病患者的SMBG频率，在不影响血糖控制的情况下节省了大量成本。
