title: Blood glucose test strips: options to reduce usage.
abstract: 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.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
mesh_terms: 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