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SMBG: not an area for cost saving

There is a worldwide epidemic of type 2 diabetes with significant morbidity, mortality and cost, and around 80 per cent of the costs relate to the management of long-term vascular complications. Attention to major risk factors, including improvement in diabetes control, produces long-term vascular benefits. This had led to recommendations from the National Institute for Health and Clinical Excellence (NICE) for a target HbA 1c of 6.5 per cent for the first two treatment steps. We are dealing with a progressive disease, however, that commonly requires combination treatment to achieve glycaemic control. This in turn may require the use of drugs such as sulphonylureas and insulin that can cause hypoglycaemia. For the above reasons, one might intuitively expect a greater need for self-monitoring of blood glucose (SMBG) to help patients manage their condition, including achievement of desired targets while avoiding hypoglycaemia. Various bodies have questioned the value of this, however, including the National Prescribing Centre, which concluded ‘There is no evidence to support current recommendations for self monitoring in type 2 diabetes’. 1 Lack of evidence, however, does not necessarily mean ‘no value’.