Asking diabetics who don't take insulin to monitor their own blood glucose levels is a waste of health resources, two new studies suggest.
The studies, appearing in this week's issue of the Canadian Medical Association Journal, conclude that the costs of the test strips outweigh the modest benefits that glucose monitoring provides to patients with type 2 diabetes who don't need insulin.
The authors of one study say Ontario could save tens of millions of dollars by cutting back on the number of unnecessary glucose tests.
Patients with diabetes who need insulin take tiny blood samples several times a day to measure levels of glucose in their blood and adjust their insulin accordingly. But the benefits of monitoring blood glucose in patients who manage their Type 2 diabetes with medications and not insulin has often been questioned.
"The degree to which patients can adjust the dose of oral antidiabetes drugs in response to readings is limited," the CMAJ authors note.
To measure the costs of the test strips, researchers at the Institute for Clinical Evaluative Sciences and St. Michael's Hospital looked at how much test strips cost the Ontario Public Drug Programs, which cover health care costs for Ontario seniors, residents of long-term care homes, those who receive home care and social assistance, and people who have high drug costs compared to their income.
They noted that the use of test strips has increased by almost 250 per cent from 1997 to 2008. The strips are now the third largest cost for Ontario drug programs, accounting for $100 million, or 3.3 per cent, of drug spending in 2007-08.
More than 50 per cent of patients with diabetes over the age of 65 received a prescription for test strips in 2008 at a total cost of $85.5 million. And with diabetes rates rising and the population aging, they project that the cost of the strips for older Ontarians would exceed $500 million between 2009 and 2013.
And yet, they say, almost half of those prescribed test strips were at relatively low risk for what's called "drug-induced hypoglycemia" -- low blood sugar from medication -- and therefore may not have benefited from the monitoring.
"Routine use of blood glucose test strips may not actually improve outcomes and quality of life among most adults with type 2 diabetes treated by oral hypoglycemic agents [diabetes medications]," Tara Gomes, principal investigator and ICES epidemiologist said in a statement.
The authors of the second CMAJ study say that for most Type 2 diabetics not using insulin, using test strips seven or more times a week is unlikely to be a good use of health care resources. They note that periodic testing, perhaps one or two times per week, would be more cost-effective in many cases.
The authors say new policies should allow more selective and less frequent testing, to make test strip use more efficient. The cost savings could then be redirected to "more effective interventions for patients with diabetes."
"In light of the overall costs and questionable benefits of blood glucose self-monitoring in many patients, more focused policy decisions regarding test strips have been proposed in several jurisdictions," says Muhammad Mamdani, a co-author and Director of the Applied Health Research Centre at St. Michael's Hospital.
