More than half of patients with type 2 diabetes being managed with treatments other than insulin who filled three or more claims for test strips may have used those supplies inappropriately, according to a report recently published in JAMA Internal Medicine.
“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,” Kevin D. Platt, MD, of the department of internal medicine, University of Michigan, and colleagues wrote.
They conducted a retrospective analysis of 86,747 claims filed by patients with type 2 diabetes who were not using insulin.
Platt and colleagues found that 51,820 patients were possibly using the supplies inappropriately; 32,773 took agents not considered to be a risk for causing hypoglycemia and 19,047 had no claims for any antidiabetic medications. In addition, the median claims cost for test strips was $325.54 (interquartile range [IQR] 0-534.76) per person per year and the mean consumer copayment for test strips was $18.14 per year (median, $0, IQR, 0-0).
“Despite a lack of clinical evidence and being identified as a low-value service by the Choosing Wisely initiative, a substantial percentage of patients with type 2 diabetes may still be inappropriately self-monitoring blood glucose,” Platt and colleagues wrote.
They offered suggestions for reversing the trend.
“Clinician-facing strategies might include clinical decision support in electronic medical records that create an alert when ordering test strips for patients who are taking nonhypoglycemic medications. Similar tools have reduced inappropriate testing of vitamin D levels,” they wrote.
“Clinical decision support and interventions such as data feedback, physician communication training, clinician scorecards, and pharmacist review should be aligned with patient-centered strategies such as shared decision making and increased consumer cost sharing (eg, value-based insurance design) to effectively reduce low-value care, while preserving the use of self-monitoring of blood glucose when it is clinically indicated,” Platt and colleagues concluded. - by Janel Miller
Disclosure s : Platt reports no relevant financial disclosures. Please see the report for all other authors’ relevant financial disclosures.