Some people with type 2 diabetes are asked to test their blood sugar levels regularly, but a new study suggests that many people test too often. The study was published on December 10, 2018 in JAMA Internal Medicineconcludes that millions of dollars could be lost due to unnecessary testing.
“More is not always better when it comes to medical care. We need to look at what we use our healthcare money for,” says the paper’s first author, Kevin Platt, MD, a resident internist at the University of Michigan in Ann Arbor.
According to American Diabetes Association. But only some of these people need a home glucose test.
“The test is generally recommended for patients who are taking insulin or medications that affect blood sugar levels,” he says. “We also consider it for a short period of time if you’re titrating your medication or doing some sort of extensive lifestyle modification.”
Home tests are usually not necessary for patients who take oral medications, such as Glucophage (metformin), he says. Instead of a home test, doctors usually order a blood test, called a hemoglobin A1C test, every three to six months. “The A1C test gives you a three-month average of what your blood sugar was like, and that’s what we’ll use to make medication changes,” he says.
Related: 5 Ways To Lower Your A1C Level
The surprising percentage of people who might test glucose unnecessarily
Dr. Platt decided to consider the frequency of home tests after noticing that some patients who did not need the test kept accurate notes of their daily blood sugar measurements over long periods of time. Researchers, including a senior author A. Mark Fendrick, MD, a professor of general medicine at the University of Michigan, reviewed National Insurance data from 370,740 people with type 2 diabetes. They reviewed the data from January 1, 2013 to June 30, 2015 — after several medical societies issued guidelines to limit unauthorized home glucose tests. necessary. The data reflects patients with private insurance or Medicare Advantage plans who do not take insulin who filled prescriptions for packages containing 90 test strips three or more times a year. This pattern of prescriptions indicated that patients were regularly monitoring their blood sugar levels.
The study found that 14 percent of people (1 out of 7) who likely wouldn’t need glucose monitoring were using an average of two test strips per day.
“We were surprised by how widespread this was,” Platt says. “We also found that nearly 25 percent of people were filling at least three prescriptions as opposed to at least 90 strips — 180 strips in a given year. These were people who had not been checking their blood sugar for a month or so. This was a use regularly over a period of time.
While the test doesn’t physically harm these people, it wastes valuable healthcare money, he says. “The claim cost to insurance companies was on average $325 per person per year, and maybe that’s not a lot on a small scale, but when you extrapolate a large number of people who do, it has huge implications for the system.”
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Do you need to test your blood sugar at home?
Research over the past decade has provided strong evidence that home glucose testing is not of value to many patients, he says. Guillermo E. Umpierrez, MD, professor of medicine at Emory University and chair of the division of diabetes and endocrinology at Grady Health System in Atlanta. Dr. Ombres was not involved in the study. He says about 80 percent of people with type 2 diabetes take metformin or other medications that are not associated with daily fluctuations in blood sugar levels.
“The benefit of home glucose monitoring has been found to be of questionable importance in several studies over the past decade,” Ombreez says. “In patients with type 2 diabetes who are not on insulin, the use of home glucose monitoring has very little effect on improving glycemic control. Several other studies have shown the same.”
Three medical societies – American Academy of Family PhysiciansAnd the General Internal Medicine AssociationAnd the Endocrine Society All have issued guidelines for home glucose testing. Those recommendations were based on 2012 study by Cochrane database system review which analyzed 12 randomized clinical trials of more than 3,000 participants. The meta-analysis showed no differences in glycemic control or hypoglycemic events (when blood glucose drops too low) between patients who do not self-monitor several times a day and those who do.
The guidelines are reflected in Choose the initiative wiselyAn attempt to reduce wasted spending on health care.
Ombreez says clinicians and patients should consider the downside of unnecessary testing.
“Unfortunately, many clinicians require patients to have frequent tests to assess glycemic control. It’s unnecessary. It’s expensive. It’s painful. There’s even some data to suggest it may reduce quality of life.”
Platt says the new study should raise awareness among patients, pharmacists, and providers about: Is this a necessary service for my patients? Sit and talk. Patients shouldn’t be afraid to ask a doctor, “Hey, why do I check sugars so often?”
