OBJECTIVES: An increasing number of studies is demonstrating that postprandial blood glucose peaks (PPG), which are not necessarily reflected by higher HbA1c values, represent a strong risk factor for the development of cardiovascular complications. This study aims to assess the economic effects of an improved glycemic control by self-monitoring of blood glucose (SMBG) with respect to coronary artery disease (CAD).METHODS: We used a Markov model based on the UKPDS risk engine, comparing two type 2 diabetic cohorts (100 % male, age 57 years, BMI 29.0, systolic blood pressure 140 mmHg, total cholesterol 5.98 mmol/l, HDL 1.27 mmol/l, baseline HbA1c 8.0 %), whereas one cohort performed (SMBG) and the other not. In a first scenario, we assumed a HbA1c improvement of 0.6% in the SMBG group compared to the control group. In a second scenario, an additional reduction of PPG from 10 mmol/l to 7.8 mmol/l was assumed in the SMBG group.RESULTS: In scenario 1 the mean life expectancy was 8.35 years (SMBG) vs. 8.33 years (No-SMBG), total cost was €15,793 (SMBG) and €11,217 (No-SMBG). In scenario 2 the mean life expectancy was 8.19 years and 8.01 years (SMBG / No-SMBG group, respectively). The cost effectiveness ratio (ICER) of using SMBG was €228,800 per life year gained (LYG) in scenario 1 and €20,083/LYG (scenario 2).CONCLUSIONS: Using only HbA1c as risk factor for CAD leads to an underestimation of the potential benefits of SMBG compared to the combination of HbA1c and PPG. This may lead to a restricted use or even to the exclusion of a worthwhile health technology. The present assessment is focused only on CAD and represents a conservative approach. Further, it has to be examined whether PPG shows similar effects in other diabetes related complications.