Differences in self-monitored, blood glucose test strip utilization by therapy for type 2 diabetes mellitus

Abstract

AimsTo determine whether blood glucose test strip (BGTS) utilization in patients with type 2 diabetes (T2D) is associated with the type of diabetes therapy, classified according to hypoglycemic risk.MethodsA retrospective, longitudinal (2006–2012) study of Canadian private drug plans (PDP) and Ontario Public Drug Programs (OPDP) prescription claims was conducted. Analyses were restricted to patients with T2D with or without a claim for BGTS. Daily BGTS utilization (TS/patient/day) was evaluated by diabetes therapy classified by hypoglycemic risk. Multivariate analyses were conducted to identify determinants of BGTS utilization.ResultsThe T2D cohort comprised 5,759,591 observations from 1,949,129 claimants. Mean BGTS utilization was 0.84 TS/patient/day and differed between PDP and OPDP (0.66 vs. 1.00). Daily utilization was greatest in patients receiving therapy associated with a pre-defined high risk of hypoglycemia [insulin: basal + bolus (2.16), premixed (1.65), basal (1.16), other insulin regimens (2.13), and sulfonylureas (0.74)] versus non-sulfonylurea non-insulin-based regimens (0.52). For non-insulin therapy, BGTS utilization was greater for patients on multiple non-insulin therapies versus monotherapy (0.74 vs. 0.53 TS/patient/day). In multivariate analyses, drivers for BGTS utilization included insulin use, previous BGTS use, and female gender. Previous diabetes therapy and duration of therapy were negatively correlated with BGTS utilization.ConclusionsBGTS utilization varies depending on the type of therapy used to treat T2D according to hypoglycemic risk. Decision making regarding BGTS needs to account for robust analyses of current utilization and its value in those settings, including in patients not receiving diabetes therapy and the prevalence of circumstances conducive to more intensive monitoring.

Cost-Effectiveness of Monitoring Metabolic Control

“…Non-insulin treated people with type 2 diabetes were using 15–23 test strips per month, people treated with basal insulin were using 32 test strips per month, and people with type 2 diabetes on basal-bolus insulin treatment were using 53–58 test-strips per month [ 46 ]. Similar findings were reported from other developed countries, such as Canada, the UK and France [ 47 – 49 ].…”

Patterns, Policy and Appropriateness: A 12-Year Utilization Review of Blood Glucose Test Strip Use in Insulin Users

“…The most important strength is the use of full population data, with all ages included. Past studies have been limited by selected populations (>65 years of age), insurance coverage (private insurance) or inferred populations from a selected sample (4,9,16,(24)(25)(26)23,28). This study's focus on insulin users over an extended period of time (13 years) is also a strength.…”

“…This grouping of regimens is adapted from the clinical practice guidelines approaches to treatment and testing (20)(21)(22). Similar groupings have been used in a previous study of BGTS and insulin use (23). Individuals' regimens were determined by the most intensive treatment regimen they used in each year.…”