Cost-Effectiveness of Monitoring Metabolic Control

Smokovski, Ivica

Glycaemic control depends more on the frequency of glucose monitoring and less on the method of delivering insulin. Despite the increase of CGM users in developed countries, SMBG is the only option of glucose monitoring for the majority of people with diabetes. Frequent SMBG is key to achieve glycaemic targets correlating with HbA1c < 7%, and associated with reduced risk of diabetes complication. Although there are numerous advantages of using HbA1c, it also has limitations and is estimated that 14–25% of the HbA1c results in clinical practice are misleading. Novel glucometrics have been introduced with the wider use of CGMs, and were associated with reduction of microvascular complications in people with diabetes. These glucometrics could also be used with BGMs, of great importance for developing countries where CGMs would not be widely available soon. Centralized procurement could result in reduction of prices per test strip. Considerable increase in the number of free test strips in settings with limited resources has resulted in reduction of acute diabetes emergencies. There is an underutilization of SMBG both in developed and developing countries. Frequent use of SMBG and novel glucometrics in developing countries could be cost-effective in reduction of diabetes complications.