In a primary care setting, educational interventions combined with comprehensive care coverage resulted in long-term improvement in clinical, metabolic and psychological outcomes at the best cost-effectiveness ratio.

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Estimate the effects on glycosylated hemoglobin (HbA 1c ) and the accumulated cost of treatment of the use and provision of various self-monitoring of blood glucose (SMBG) regimes plus conventional pharmacologic treatment on type-2 diabetic (T2D) patients from the Mexican public health system perspective. METHODS: The individual experience of a T2D patient was simulated using a discrete event simulation (Arena™). Patients were created with unique, randomly assigned baseline characteristics, cloned three times and sent to each of the considered SMBG regimes (0, 1, 2 and 3 times daily). T2D-and complication-related pharmacologic treatment & resource utilization, and treatment algorithms and goals were based on published clinical guidelines. Treatment therapies included lifestyle modifications alone, oral antidiabetics (OADs) and insulin use. HbA1c was the main driver of disease progression, determining initial state, clinical evolution and drug/insulin dosages. Complication and acute event development for each SMBG regime was assessed through published local relative risk studies. Considered OADs and insulin types were assumed equally effective. Clinical and cost data were obtained from published literature. Mortality was assessed by disease duration. Simulation was run with 250,000 patients for 10 years using a 4.5% annual discount rate. Average per-patient costs are shown in inflation-adjusted 2011 MXP. RESULTS: More intensive SMBG regimes resulted in lower final average HbA1c levels; 1, 2 and 3 times daily SMBG regimes resulted in lesser costs than no SMBG after years 3, 3 and 4, respectively.