Ann Arbor, MI—Pharmacists might be surprised by how many of the diabetes patients who buy test strips are monitoring their blood sugars way too often and/or unnecessarily.
A study published in JAMA Internal Medicine found that 14% of type 2 diabetes patients not using insulin purchase enough test strips to measure blood glucose two or more times a day.
University of Michigan researchers note that “Low-value care worsens patient-centered outcomes and imparts a negative economic effect, which has prompted the Choosing Wisely campaign to promote a national dialogue on the judicious use of services that are deemed to be nonbeneficial.”
The study points out that clinicians should “avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia.”
Researchers sought to quantify the rate of use and cost of self-monitoring blood-glucose supplies that are potentially used inappropriately. Their primary focus was test strips, which are the most costly supply for regular blood-glucose monitoring.
To determine that, the study team performed a retrospective analysis of claims data from January 1, 2013, to June 30, 2015, from the deidentified Clinformatics Data-Mart Database (OptumInsight), which includes commercial health insurance beneficiaries and Medicare Advantage beneficiaries.
Included in the analysis were adults who were not pregnant; continuously enrolled for a minimum of 2 years from January 1, 2013, through December 31, 2014; and had two office visits less than 181 days apart, or one emergency department visit or one hospitalization with a diagnosis of type 2 diabetes.
The more than 370,000 patients, who had a mean age of 68.5 years, were followed for at least a year after filling a prescription for test strips or for the calendar year of 2014 if no prescription was filled. Researchers only included patients with three or more claims for test strips, which suggested routine use, as well as those with no claims for test strips within the 1-year study period.
Results indicate that 23.4% filled three or more claims for test strips during the course of the year. Yet more than half of those patients—14% of the study population—were determined to be potentially using the supplies inappropriately.
Overall, the study found that 32,773 patients were taking agents not considered to be a risk for causing hypoglycemia, such as metformin, and that 19,047 patients actually had no claims for any antidiabetic medications.
Patients in those two groups used a median of two strips per day (interquartile range, 1.2-2.4), however, at a median claims cost for test strips of $325.54 (interquartile range, $0.00-$534.76) per person per year. The mean (SD) consumer copayment for test strips was $18.14 ($54.94) annually.
The report emphasizes that three different medical societies—the American Academy of Family Physicians, the Society of General Internal Medicine, and the Endocrine Society—have issued guidance for physicians stating that such patients do not need to regularly test their sugar levels.
“One of my patients who didn’t need to be testing daily told me that her previous doctor had told her to test her sugars two or three times a day,” explained Kevin Platt, MD, the internal medicine resident who led the analysis. “These data show that over-testing is quite common—and with the appropriate guidance can be reduced significantly.”
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A study published in JAMA Internal Medicine found that 14% of type 2 diabetes patients not using insulin purchase enough test strips to measure blood glucose two or more times a day.
University of Michigan researchers note that “Low-value care worsens patient-centered outcomes and imparts a negative economic effect, which has prompted the Choosing Wisely campaign to promote a national dialogue on the judicious use of services that are deemed to be nonbeneficial.”
The study points out that clinicians should “avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia.”
Researchers sought to quantify the rate of use and cost of self-monitoring blood-glucose supplies that are potentially used inappropriately. Their primary focus was test strips, which are the most costly supply for regular blood-glucose monitoring.
To determine that, the study team performed a retrospective analysis of claims data from January 1, 2013, to June 30, 2015, from the deidentified Clinformatics Data-Mart Database (OptumInsight), which includes commercial health insurance beneficiaries and Medicare Advantage beneficiaries.
Included in the analysis were adults who were not pregnant; continuously enrolled for a minimum of 2 years from January 1, 2013, through December 31, 2014; and had two office visits less than 181 days apart, or one emergency department visit or one hospitalization with a diagnosis of type 2 diabetes.
The more than 370,000 patients, who had a mean age of 68.5 years, were followed for at least a year after filling a prescription for test strips or for the calendar year of 2014 if no prescription was filled. Researchers only included patients with three or more claims for test strips, which suggested routine use, as well as those with no claims for test strips within the 1-year study period.
Results indicate that 23.4% filled three or more claims for test strips during the course of the year. Yet more than half of those patients—14% of the study population—were determined to be potentially using the supplies inappropriately.
Overall, the study found that 32,773 patients were taking agents not considered to be a risk for causing hypoglycemia, such as metformin, and that 19,047 patients actually had no claims for any antidiabetic medications.
Patients in those two groups used a median of two strips per day (interquartile range, 1.2-2.4), however, at a median claims cost for test strips of $325.54 (interquartile range, $0.00-$534.76) per person per year. The mean (SD) consumer copayment for test strips was $18.14 ($54.94) annually.
The report emphasizes that three different medical societies—the American Academy of Family Physicians, the Society of General Internal Medicine, and the Endocrine Society—have issued guidance for physicians stating that such patients do not need to regularly test their sugar levels.
“One of my patients who didn’t need to be testing daily told me that her previous doctor had told her to test her sugars two or three times a day,” explained Kevin Platt, MD, the internal medicine resident who led the analysis. “These data show that over-testing is quite common—and with the appropriate guidance can be reduced significantly.”
« Click here to return to Weekly News Update.
