In a study published in JAMA Internal Medicine, lead author Kevin D. Platt, MD, of the Department of Internal Medicine, University of Michigan, Ann Arbor, and colleagues affiliated with the Department of Clinical Pharmacy, College of Pharmacy, and the Institute for Healthcare Policy and Innovation, University of Michigan, explored the cost and rate of use of testing strips—considered the most expensive devices and most likely to be used  incorrectly for self-monitoring of blood glucose.

The Choosing Wisely campaign was launched to foster national dialogue and to highlight recommendations, which include limiting blood glucose monitoring in specific low-risk patients.  Based on evidence from a Cochrane review that showed no statistical difference between patients who self-monitored multiple times per day compared with those who checked less frequently, the authors promoted the robust strength of this evidence, which was based on 12 randomized,  clinical trials that included over 3,000 patients.

The researchers conducted a retrospective claims analysis of 370,704 (182,042 women and 188,662 men) adults with type 2 diabetes; however, persons were excluded if they received any prescription for insulin. Subjects were followed for at least 12 months after a prescription for test strips was dispensed, and patients who did not receive strips were tracked for a specific calendar year as defined by the team. Subjects with three or more insurance claims for test strips were considered to be routine users. Roughly 24% (86,747) patients filled three or more claims during the study, and of these, more than half (51,820) were taking metformin and thus were not considered to be at high risk for hypoglycemia; they were therefore deemed to be potentially inappropriate users.

In a healthcare environment in which medication costs are escalating, Platt commented further, “The aim of this study was to quantify the rate of use and cost of self-monitoring blood glucose supplies that are potentially used inappropriately, specifically focusing on test strips, the most costly supply for regular blood glucose monitoring,” said Platt.
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