Reducing the number of blood glucose test strips for Type 2 diabetes patients not using insulin saved Ontario $24 million in one year without a negative impact on health outcomes, a new study from JAMA Internal Medicine has found.
The test strips were Ontario’s public drug programs’ third-largest expense in 2007-08, costing $100 million.
In August 2013, the province imposed annual limits on test strips: 3,000 for patients using insulin, 400 for patients on certain oral medications and 200 for all others.
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Patients on insulin should check their blood glucose levels at least four times a day, so they can adjust their insulin levels accordingly, says Tara Gomes, the study’s lead author and a scientist at both St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences.
Patients on certain oral drugs should test either daily or a few times a week, and those controlling their diabetes without medication should test between once and a few times a week. “The reason is they can’t really adjust any sort of drug therapy in response to the levels that they’re seeing,” says Gomes.
She also notes patients who aren’t using insulin may experience anxiety if they test too frequently because they may be stressed over natural fluctuations they can’t control.
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Gomes’s study found that since Ontario introduced the new limit for testing strips, patients haven’t increased visits to emergency rooms because of high or low blood sugar. “I think that’s reassuring, because this was obviously a concern that was raised when these limits were put in place, that this could lead to poor diabetes control . . .,” she says, noting the need for further research to ensure there are no adverse health outcomes in the long term.
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The study didn’t examine employer-sponsored plans, but Gomes predicts testing strips “are quite high cost drivers across the board” and suggests plan sponsors could save money by adopting similar limits.
Some insurers already have. In August 2013, Green Shield Canada introduced a 3,000-strip limit for patients using insulin and a 600-strip cap for those not using it, according to a 2013 pharmacy update. It also sends patients warning letters when they approach their cap.
