Variations in glucose self-monitoring during oral hypoglycaemic therapy in primary care

Objective: To describe the prescription of glucose self-monitoring materials in the first 12 months after initiation of oral hypoglycaemic therapy. Methods: Cohort study of subjects registered with UK general practices and prescribed oral hypoglycaemic drugs for the first time between January 1993 and December 1998. Analyses were adjusted for age, sex, year, prevalent coronary heart disease and clustering by practice. Results: Data were analysed for 11 688 subjects registered with 262 practices. The proportion who received no prescriptions for monitoring increased from 24% in 1993 to 30% in 1998; urine glucose monitoring only decreased from 45 to 27%; while blood glucose monitoring only increased from 19 to 32%. In those under 45 years, 25% were not prescribed monitoring, increasing to 53% in those aged 85 years and over. In the same age groups, the proportion prescribed blood glucose monitoring only declined from 37 to 16%. At different general practices, the proportion of patients prescribed monitoring strips ranged from 12 to 100%. Practices with more registered diabetic patients were more likely to prescribe urine glucose monitoring only. Monitoring prescriptions varied widely between England, Scotland, Wales and Northern Ireland. Among eight English regions, the proportion prescribed blood glucose monitoring only ranged from 18 to 37%. Conclusions: Prescription of glucose monitoring varies according to patient and practice characteristics and geographical location. Monitoring patterns are changing over time. These variations may reflect uncertainty concerning the effectiveness of monitoring, and diversity of patient and professional preferences with respect to monitoring.