Glucose Testing News: T2Ds May Be Overdoing It

Study finds that many people with type 2 diabetes may be overusing self-testing supplies. Learn why this matters.

African American Testing Blood Glucose with a Meter and StripUnless you are on insulin or taking medication linked to hypoglycemia, you probably don't need to be testing your blood sugar at all.

If you feel your healthcare provider is always pointing out that your diabetes management is falling short, here's a twist.  A new study suggests that many people with type 2 diabetes may be overdoing it, by using blood glucose test strips to check their sugars when it's not necessary.

In an analysis of insurance claims on more than 370,000 men and women with type 2 diabetes, and none on insulin, about 14% were probably testing too frequently, according to study author Kevin Platt, MD, chief medical resident at the University of Michigan, Ann Arbor.  The study looked at the use of test strips.1

"One in seven of those with type 2 diabetes not using insulin in this study were regularly testing blood sugar inappropriately with the strips," Dr. Platt explains. The overuse, Dr. Platt says, ''is costing money, time and painful finger sticks." And it may also cause unnecessary worry.

Under the Choosing Wisely campaign,2 whose aim is to raise discussion about the judicious use of services that are not believed beneficial, one recommendation is to ''avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia [such as metformin]," Dr. Platt and his colleagues write in JAMA Internal Medicine.

That is also the recommendation of professional medical societies, such as the Endocrine Society, he tells OnTrack Diabetes.

Study Details

To see how closely those recommendations are being followed, Dr. Platt's team conducted an analysis from January 2013 to June 2015, looking at information from commercial health insurance and Medicare Advantage databases.

They focused on those patients with type 2 diabetes not on insulin who filled three or more claims for test strips during the course of the year, totaling more than 86,000 men and women.

More than half of these, or 14% of the entire group studied, were considered to be using them inappropriately, because they were either taking medications not at risk for causing very low blood sugar or had no claims for any diabetes medicines.

The patients use a median (half more, half used less) of two strips a day. The associated costs were about $18 a year for patients, but cost insurance companies about $325 annually.

While the study has limitations, such as picking people with private insurance, it does point out a need for physicians and patients to think more thoroughly about the appropriate use of test strips.

For these patients on medicines without a hypoglycemia risk, the doctor is usually checking their A1C every three to six months, Dr. Platt says. And the doctor makes medication changes and lifestyle changes based on that A1C result, he says.

"It's rarely useful to have all this information," he says of the multiple test strip results in these patients.

Expert Opinions

Physicians who are up to date with the guidelines know this, says Elena Christofides, MD, an endocrinologist and CEO of Endocrinology Associates in Columbus, Ohio. She reviewed the findings. "Any cost-conscious endocrinologist knows this and advises this," she says explaining who needs to test and who does not. "It's not us who are driving demand for test strips."

Her advice for patients: "Don't test your sugars unless you're on meds that cause hypoglycemia and don't waste money on meters and strips 'just in case.' " If you're not sure, of course, ask your doctor.

The study finding points to the need for people with diabetes to receive self-management education at least annually, says Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE, transitional program coordinator, University of Chicago's Kovler Diabetes Center, and a member of the editorial board for OnTrackDiabetes. She also reviewed the findings.

Testing, she says, ''is one of the most important education topics to discuss to help people with diabetes understand when testing is important for them."

Hess-Fischl is a speaker for Abbott Diabetes Care. Dr. Platt has no disclosures. Dr. Christofides is a consultant for Novo Nordisk, Eli Lilly and Chiasma and is on the speakers' bureau for Pfizer; Novo Nordisk, Eli Lilly, Boehringer Ingelheim, PamLab and Shire.

Updated on: April 3, 2019
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