Bulletin
(Briefing)
45 |strips
July for
2013 | v2.2
PrescQIPP Bulletin 46 (Briefing):
Blood
glucose test
patients with type 2 diabetes mellitus
Blood glucose test strips for patients with type 2 diabetes
mellitus: Briefing
Self-monitoring of blood glucose (SMBG) is essential for people with diabetes on insulin therapy and can be
beneficial for some people on other hypoglycaemic agents. Where SMBG is not serving a specific purpose
in the management of the condition however it is a waste of resources and causes unnecessary pain to the
patient. NICE recommends that it should be used only if it is going to be an integral part of the patient’s selfmanagement education, and the continued benefit of self-monitoring should be assessed in a structured
way each year.1
In recent years the cost of prescribing blood glucose test strips has grown rapidly. In the NHS Midlands and
East in 2012/13, 22% of the whole drugs budget for diabetes was spent on blood glucose test strips at a cost
of £48.3 million.
Recommendations
•
Review current prescribing of BGTS and evaluate the need for self-monitoring on an individual
patient basis; where there is no need for SMBG discontinue prescribing.
•
Determine appropriate frequency for testing and make necessary adjustments to quantity of test
strips prescribed.
•
Remove BGTS from repeat prescriptions for patients who only need to test intermittently.
•
Use the guide provided to help produce a preferred list of blood glucose testing strips and meters
to be used locally.
•
Ensure a wide stakeholder engagement including GPs, Practice Nurses,
•
Specialist Community Diabetes teams, community pharmacists Hospital Diabetes teams and
patient representatives.
•
Implement a switch program to the formulary blood glucose meters.
Background
Around 4.5% of the adult population in the UK have been diagnosed with diabetes and it is estimated that 10%
of these have Type 1 diabetes and 90% have type 2 diabetes.3
A report published by NHS Information Centre states that in the financial year 2010/11 ‘drugs for diabetes’
was the BNF section of highest cost and greatest increase in cost and accounted for 8.4% of the total cost of
prescribing for that year.4 Over the same period there was a 6.3% increase in the number of items prescribed
of blood glucose monitoring agents and devices resulting in a rise in net ingredient cost from £142.3 million to
£152.6 million.
NICE guidance on type 2 diabetes recommends that SMBG should only be used if it is going to be an integral
part of the patient’s self-management education. The continued benefit of SMBG should be assessed in a
structured way each year, and clinicians should ensure that patients using SMBG are clear about the purpose
of the monitoring, how results should be interpreted, and what action to take in response to results.
This is an NHS document not to be used for commercial or marketing purposes
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PrescQIPP Bulletin 46 (Briefing): Blood glucose test strips for patients with type 2 diabetes mellitus
Guidance for reviewing the need to test for blood glucose
•
SMBG should only be provided routinely to people with type 2 diabetes not treated with insulin or
sulphonylureas where there is an agreed purpose or goal to testing.
•
Patients being treated with insulin or other diabetes agents that carry a risk of hypoglycaemia
(sulphonylureas, glinides) must be prescribed BGTS to allow them to satisfy the level of testing
stipulated by the Driver and Vehicle Licensing Agency (DVLA).5
•
SMBG should be used to optimise blood glucose control prior to conception and during pregnancy,
including gestational diabetes.
•
SMBG should be used only within a care package, accompanied by structured education with
regular review. The education should include clear instructions as to the place of monitoring
and how results can be used to reinforce lifestyle change, adjust therapy or alert healthcare
professionals.
•
The quantity of test strips on prescription should reflect the frequency of testing required by the
individual patient. Where testing is only required intermittently, prescriptions should be generated
only when needed and not as a repeat prescription.
Review of blood glucose testing meters/strips
Approximately £48.3million was spent on blood glucose testing strips (BGTS) in the Midlands and the East
from March 2012 to February 2013. There is a wide variety of blood glucose meters to choose from and
prescribing data shows that 41 different brands of testing strips were prescribed over this period with
prices ranging from £7.50 to £16.30 per 50 strips. There is little variation between the different meters in
their ability to provide an accurate reading of blood glucose so it stands to reason that prescribing should
be stream-lined to include only cost-effective testing strips.By switching patients on to cost-effective blood
glucose meters and testing strips the cost of prescribing can be reduced by 31% assuming a 100% switch or
25% assuming an 80% switch. This saving has been calculated using £10 as the cost limit for 50 testing strips.
This will generate a saving of £12 million to £15 million in the NHS Midlands and East which can then be
invested in improving the care of patients with diabetes.
References
1.
2.
3.
4.
5.
NICE Clinical Guidelines CG87 Type 2 diabetes: The management of type 2 diabetes
Prescribing data from NHSBSA, ePACT. The prescribing data for the 12 months from March 2012
to February 2013 has been used to calculate this figure.
Diabetes UK http://www.diabetes.org.uk/Professionals/Publications-reports-and-resources/Reports-statisticsandcase-studies/Reports/Diabetes-in-the-UK-2012/
‘Prescribing for Diabetes in England: 2005/6 to 2010/11’ NHS Information Centre https://catalogue.ic.nhs.uk/publications/prescribing/primary/pres-diab-upda-eng-2005-2011/presdiab-eng-2005-2011-rep.pdf
At a glance guide to the current Medical Standards of Fitness to Drive. http://www.dft.gov.uk/dvla/medical/aag.aspx
Information prepared by Belinda Ekuban, NHS PrescQIPP Programme, July 2013, and reviewed by Katie
Smith, East Anglia Medicines Information Service, August 2013. This briefing is also accompanied by a
bulletin, which is available at:
http://www.prescqipp.info/blood-glucose-testing-strips/viewcategory/200
This is an NHS document not to be used for commercial or marketing purposes
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