Patients with stable type 2 diabetes (T2D) not receiving insulin may be unnecessarily self-monitoring blood glucose levels despite this practice being recognized as a low-value service that increases expense without improving patient outcomes, according to a research letter published in JAMA Internal Medicine.

The Choosing Wisely campaign works to promote a dialogue between physicians and patients regarding low-value care that leads to negative economic effects and worse patient-centered outcomes. One of its recommendations is that adults with stable T2D who are not taking agents that cause hypoglycemia should avoid routine self-glucose monitoring multiple times a day. Studies have shown no statistical difference in outcomes between patients who do frequently self-monitor vs those who do not. 

In the current study, researchers quantified the cost and rate of inappropriate use of blood glucose monitoring supplies, focusing on test strips in particular. Investigators performed a retrospective analysis of data from the Clinformatics Data-Mart Database (OptumInsight), focusing on claims data between January 2013 and June 2015. Patients included for analysis were aged ≥18 years, had T2D, and did not receive a prescription for insulin. Participants were followed for ≥1 year after filling a prescription for glucose test strips or for the 2014 calendar year if they did not fill a prescription for test strips.

Of the 370,740 patients meeting the inclusion criteria (mean age, 68.5 ± 12.1 years; 188,662 men, 182,042 women, and 36 unknown), 23.4% (n = 86,747) filled ≥3 claims for glucose test strips throughout the year. More than half of these patients (n = 51,820) were determined to be potentially using the test strips inappropriately; 32,773 were taking agents that did not put them at risk for hypoglycemia and 19,047 did not have claims for any antidiabetic medication. These patients used a median of 2 test strips/day and had a median claims cost/year of $325.54 and a mean annual consumer copayment of $18.14 ± $54.94.

Study limitations included risk for bias because data were based on only private insurance users and were unable to account for lifestyle/medication changes or transient episodes of hypoglycemia that might have required monitoring. The study also did not include medications that were paid for without a claim.

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The study investigators concluded that “clinical decision support and interventions such as data feedback, physician communication training, clinician scorecards, and pharmacist review should be aligned with patient-centered strategies such as shared decision making and increased consumer cost sharing (eg, value-based insurance design) to effectively reduce low-value care, while preserving the use of self-monitoring of blood glucose when it is clinically indicated.”

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Reference

Platt KD, Thompson AN, Lin P, Basu T, Linden A, Fendrick AM. Assessment of self-monitoring of blood glucose in individuals with type 2 diabetes not using insulin [published online December 10, 2018]. JAMA Intern Med. doi: 10.1001/jamainternmed.2018.5700