Self-monitoring of blood glucose: guideline 1 application rather than utilization restrictions on testing strips has potential to reduce diabetic healthcare costs in Italy

Background: Self-monitoring of blood glucose (SMBG) is a proven tool to improve glycemic control, even if it might increase direct costs for diabetes management. In Italy, the purchase, prescription rules and responsibilities, and distribution of testing strips per type of patient are managed differently in each of the 20 Italian regions. The Italian Scientific Societies for diabetes (Società Italiana Diabetologia, SID and Associazione Medici Diabetologi, AMD) issued validated guidelines for SMBG, but not all Regions apply them. We investigated whether following SID-AMD guidelines would help decreasing SMBG and diabetes healthcare costs in Italy. Methods: We compared the regions applying and not applying SMBG-guidelines for the mean number of testing strips utilized, number of hospitalizations (with the principal diagnosis of diabetes, excluding diabetic complications) and duration of hospitalization, as indirect measures of SMBG cost. Results: Regions applying the guidelines recorded higher SMBG testing strip utilization than regions not applying guidelines, but they recorded fewer hospitalizations for diabetes (36.2± 11.3 vs. 79.9 ± 27.8 hospitalizations per 100,000 inhabitants, p<0.002) and fewer days in hospital (363 ± 106 vs. 685 ± 194 days of hospitalization for diabetes per 100,000 inhabitants, p<0.002). Conclusions: Our data suggest that application of guidelines for SMBG prescription and a strict cooperation between health providers and regional health economic deciders were associated with greater utilization of SMBG testing strips. They were also associated with significantly reduced number of hospitalizations and reduced overall duration of hospitalization for patients with diabetes, potentially saving healthcare costs.