Low-Value, Blood Glucose Self-Monitoring is Common

A substantial percentage of patients with type 2 diabetes may be inappropriately self-monitoring blood glucose, according to a research letter published Dec. 10 in JAMA Internal Medicine. Despite recommendations to the contrary, nearly one in seven patients with type 2 diabetes, but not using insulin, filled three or more claims for test strips over a one-year period. Interventions, the authors say are needed to curb this low-value testing.

Using claims data (Jan, 1, 2013, through June 30, 2015), from the Clinformatics Data-Mart Database (OptumInsight), the researchers identified 370,740 individuals (182 042 women; mean age, 68.5) who had two office visits less than 181 days apart, or either one emergency department visit or one hospitalization with a diagnosis of type 2 diabetes. Patients were followed for at least one year after filling a prescription for test strips, but were excluded if they received any prescription for insulin. Three or more claims for test strips were used to define routine testing.

The researchers found that less than one-quarter of patients (23.4 percent) filled three or more claims for test strips over the one-year timeframe. More than half of these individuals (51,820 of 86,747 routine testers) were potentially testing inappropriately, given that 32,773 individuals were taking agents not considered to be a risk for causing hypoglycemia (e.g., metformin hydrochloride) and 19,047 had no claims for any antidiabetic medications.

These 51,820 potentially inappropriate testers used a median of 2.0 strips per day, with median claims cost for test strips of $325.54 per person per year. The mean consumer copayment for test strips was $18.14 annually.

While the authors, led by Kevin D. Platt, M.D., from University of Michigan, Ann Arbor, warn that they although they were unable to account for changes in medications, lifestyle, or transient episodes of hypoglycemia that might warrant monitoring, they believe “strategies to improve engagement among clinicians and to educate patients are warranted to reduce low-value care.” They suggest clinician-facing strategies might include clinical decision support in electronic medical records that create an alert when ordering test strips for patients who are taking  nonhypoglycemic medications.

Takeaway: Efforts are needed to curb low-value, self-testing of blood glucose among patients with type 2 diabetes—particularly those who are not taking antidiabetic medications.