Access to Glucose Monitoring Supplies Linked to Mortality Rates

NASHVILLE, Tenn. — There appears to be a negative association between survival and acquisition of self-monitoring blood glucose supplies, according to a new study presented at the American Association of Clinical Endocrinologists (AACE) 24th Annual Scientific & Clinical Congress. 

Researchers conducted an analysis of the importance of Medicare beneficiaries with diabetes having a proper supply of blood glucose monitoring tools. They found higher mortality among beneficiaries who obtained fewer supplies than the year before and lower mortality among beneficiaries who obtained more supplies than the year before.

“From our perspective, safeguards must be put in place to monitor changes in acquisition and ensure that patient lives are not being jeopardized,” said study author Jaime Davidson, MD, who is the President of Endocrine and Diabetes Associates of Texas and is also a clinical professor of medicine at the University of Texas Southwestern Medical School in Dallas. 

Davidson and his colleagues investigated the potential disruption of patient access to blood glucose monitoring supplies and its impact on health outcomes following the recent implementation of the Centers for Medicare and Medicaid Services’ (CMS) competitive bidding program.

The CMS implemented a trial of a competitive bid process for diabetes supplies in nine test sites in January 2011 and then a year later stated the program was a success. The CMS said beneficiary access to supplies was not compromised with the bidding process. The program was implemented nationally in July 2013. 

The investigators assessed the impact of full acquisition of blood glucose testing supplies compared with partial acquisition on mortality among insulin-treated Medicare beneficiaries. The researchers defined full self-monitoring blood glucose (SMBG) acquisition as >80 of test strips covered, based on three test strips per day.

The researchers found that 71.1% of the beneficiaries were treated with rapid-acting insulin, including analog pre-mix, and 20.4% with rapid-acting and long-acting insulin, including analog, recombinant human pre-mix. They reported that 4-year survival was negatively associated with partial or no SMBG acquisition in both groups (P<.0001).

The mortality rates were higher among beneficiaries with full SMBG acquisition in 2010 who migrated to partial SMBG acquisition or no SMBG record the next year compared with maintaining full SMBG acquisition.

However, the mortality rates were lower among beneficiaries with partial SMBG acquisition or no SMBG record in 2010 but migrated to full SMBG acquisition the next year, according to the researchers.

“As a physician, I’m concerned that CMS did not report any changes in acquisition of SMBG supplies in their initial report of the competitive bidding program. We’re continuing to look at the data to understand more about the full impact, but at this stage, given that acquisition of blood glucose monitoring supplies is indicative of actual blood glucose monitoring, anything that disrupts acquisition has a very strong potential to impact patient safety,” Davidson told Endocrinology Advisor.

Reference

1. Parkin C et al. Abstract #1230. Presented at: American Association of Clinical Endocrinologists (AACE) 24th Annual Scientific & Clinical Congress; May 13-17, 2015; Nashville, Tenn.