APPENDIX

To estimate the long term cost effectiveness of self monitoring of blood glucose in addition to standardised usual care for non-insulin treated type 2 diabetes, we carried out a secondary analysis of the randomised controlled diabetes glycaemic education and monitoring (DiGEM) trial data predicting the lifetime quality adjusted life expectancy and diabetes complication costs. Main risk factors from the DiGEM study were extrapolated beyond the 12 months trial follow-up using modelling techniques. The extrapolation showed that the initial 12 months effects were only partly offset by incremental lifetime gains in diabetes complication costs and quality adjusted life expectancy that may be achieved from lower risk factor levels achieved by selfmonitoring of blood glucose. The long term results support the findings of the within-trial economic evaluation that self monitoring of blood glucose with or without additional instruction in incorporating findings in self care is unlikely to be cost effective in addition to standardised usual care.