Blood glucose test strips: options to reduce usage.
BACKGROUND
Recent evidence suggests that, despite widespread use, self-monitoring of blood glucose levels has little clinical benefit in many patients with diabetes. The impact of more focused public-payer policies for the use of blood glucose test strips may be substantial.


METHODS
We conducted a cross-sectional analysis of annual prescription claims for test strips between 1997 and 2008 for patients in Ontario aged 65 and older with diabetes. Patients were stratified into 1 of 4 hierarchical groups according to the most intensive glucose-lowering treatment received during each calendar year. Test strip use was calculated annually for each group over the study period, and the effects of 5 hypothetical policy scenarios of more selective test strip use were assessed.


RESULTS
Test strip use increased by almost 250% from 1997 to 2008, with 52.6% (n = 263,513) of included patients receiving a prescription during 2008. Almost half of these patients were at low risk for drug-induced hypoglycemia. In 2008, over 117 million test strips were dispensed in Ontario; however, more focused policy scenarios could have reduced this number by between 9.5 million and 74.5 million test strips.


CONCLUSIONS
Many people who self-monitor their blood glucose are at relatively low risk for drug-induced hypoglycemia. The economic benefits associated with more selective testing could be redirected to more effective interventions for patients with diabetes.
Gomes
Tara
T
Institute for Clinical Evaluative Sciences, Toronto, Ont.
Juurlink
David N
DN
Shah
Baiju R
BR
Paterson
J Michael
JM
Mamdani
Muhammad M
MM
D015190:Blood Glucose Self-Monitoring / Q000191:economics*; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000191:economics*; D005102:Health Expenditures; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D008875:Middle Aged; D009864:Ontario