CMAJ • January 12, 2010; 182 (1).
First published December 21, 2009; doi:10.1503/cmaj.091017
© 2010 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
Tara Gomes, MHSc ,
David N. Juurlink, MD PhD ,
Baiju R. Shah, MD PhD ,
J. Michael Paterson, MSc and
Muhammad M. Mamdani, PharmD MA MPH
© 2010 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Blood glucose test strips: options to reduce usage
From the Department of Medicine (Juurlink, Shah), Sunnybrook Health Sciences Centre, Toronto, Ont.; St. Michael’s Hospital (Mamdani) Toronto, Ont.; the Departments of Medicine (Mamdani, Juurlink, Shah), Pediatrics (Juurlink), and Health Policy, Management, and Evaluation (Mamdani, Juurlink, Shah), University of Toronto, Toronto, Ont.; the Institute for Clinical Evaluative Sciences (Gomes, Mamdani, Juurlink, Paterson, Shah), Toronto, Ont.; the Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; and the Centre for Evaluation of Medicines (Paterson), St. Joseph’s Healthcare; Hamilton, Ont.
Correspondence to: Muhammad M. Mamdani, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond St., Toronto ON M5B 1W8; mamdanim{at}smh.toronto.on.ca
Background: Recent evidence suggests that, despite widespread use, self-monitoring of blood glucose levels has little clinical benefit in many patients with diabetes. The impact of more focused public-payer policies for the use of blood glucose test strips may be substantial.
Methods: We conducted a cross-sectional analysis of annual prescription claims for test strips between 1997 and 2008 for patients in Ontario aged 65 and older with diabetes. Patients were stratified into 1 of 4 hierarchical groups according to the most intensive glucose-lowering treatment received during each calendar year. Test strip use was calculated annually for each group over the study period, and the effects of 5 hypothetical policy scenarios of more selective test strip use were assessed.
Results: Test strip use increased by almost 250% from 1997 to 2008, with 52.6% (n = 263 513) of included patients receiving a prescription during 2008. Almost half of these patients were at low risk for drug-induced hypoglycemia. In 2008, over 117 million test strips were dispensed in Ontario; however, more focused policy scenarios could have reduced this number by between 9.5 million and 74.5 million test strips.
Interpretation: Many people who self-monitor their blood glucose are at relatively low risk for drug-induced hypoglycemia. The economic benefits associated with more selective testing could be redirected to more effective interventions for patients with diabetes.
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eLetters:
Read all eLetters
- Blood Glucose Test Strips cost
- Josef Meshorer
- CMAJ, 24 Dec 2009 [Full text]
- Re: Blood Glucose Test Strips cost
- Walter Wasylko
- CMAJ, 4 Jan 2010 [Full text]
- In Response To “Blood Glucose Test Strips: Options to Reduce Usage”
- David C. Klonoff, M.D., FACP
- CMAJ, 6 Jan 2010 [Full text]
- In reponse to David Klonoff
- Muhammad Mamdani
- CMAJ, 26 Jan 2010 [Full text]