title: Patients who self-monitor blood glucose and their unused testing results.
abstract: OBJECTIVE
  To investigate the prevalence, predictors, and costs associated with unused results from self-monitoring of blood glucose (SMBG).
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  We studied 7320 patients with type 2 diabetes mellitus who were not prescribed insulin and who reported SMBG. Patients reported whether they used SMBG results to make adjustments to diet, exercise, or medicines; and whether their physician/provider reviewed their SMBG results. We categorized SMBG results as "used" (by patient and/or provider) or "unused" (not used by either patient or provider).
  
  
  RESULTS
  SMBG results were unused by patient and provider in 15.2% of patients. In separate models adjusted for demographic and clinical differences, major predictors of SMBG without patient or physician using the results included a patient reporting that diabetes was not a high priority (relative risk [RR], 1.81; 95% CI, 1.58-2.07); the physician not engaging in shared decision making (RR, 1.66; 95% CI, 1.46-1.90); and no healthcare professional teaching the patient how to adjust diet/medicines based on SMBG results in the past year (RR, 2.27; 95% CI, 2.00-2.57). Patients with unused results were dispensed 171 ± 191 test strips per year at an estimated annual cost of $168.
  
  
  CONCLUSIONS
  Nearly 1 in 6 non-insulin-treated patients practiced SMBG without either the patient or physician using the results. This represents a wasteful and ineffective practice for patients and health systems alike. Our results suggest that the decision to initiate and continue SMBG must be made in concert with the patient's own priorities, and, if prescribed, SMBG requires effective patient provider communication and patient education.
authors.affiliation: 2101 Webster St, 20th Fl, Oakland, CA 94612. E-mail: Richard.W.Grant@kp.org.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grant
authors.forename: Elbert S
authors.initials: ES
authors.lastname: Huang
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Wexler
authors.forename: Neda
authors.initials: N
authors.lastname: Laiteerapong
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Warton
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000191:economics* / Q000706:statistics & numerical data*; D002140:California; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D000068598:Data Accuracy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D013223:Statistics as Topic / Q000379:methods*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents