Limiting reimbursement for blood glucose test strips does not harm patients and reduces costs

A provincial plan implementing quantity limits on blood glucose test strips for patients with Type 2 diabetes not using insulin does not put those patients at risk and has saved the province of Ontario $24 million, according to a new study published in JAMA Internal Medicine.

Self-monitoring of blood glucose for patients with diabetes on insulin is considered an essential part of their health management because they can use the results to adjust their medication throughout the day. However, for most patients with Type 2 diabetes not using insulin, frequent monitoring with blood glucose test strips is not considered clinically beneficial and may lead to decreased quality of life and well-being. For patients with diabetes who do not use insulin, it is rare for blood glucose levels to drop to dangerous levels, and so these patients generally do not need to test their blood glucose levels daily. Instead, testing just a few times a week can provide their physician with helpful information as to whether their oral medications need to be adjusted.

Earlier studies examined the total cost of test strips and found they were the third largest cost for the Ontario Public Drug Programs in 2007/08, accounting for $100 million or 3.3 per cent of drug expenditures. In 2013, the Ontario Public Drug Programs implemented a policy restricting reimbursement for blood glucose test strips that aligned with recommendations from the Canadian Diabetes Association for how often patients should be doing regular blood glucose monitoring.

“The concern around limiting blood glucose test strips was that patients would end up in the emergency department with very high or low blood glucose, but what we found was that these quantity limits were not associated with any worsening of these outcomes for patients,” says Tara Gomes, lead author, a principal investigator of the Ontario Drug Policy Research Network (ODPRN), and a scientist at both the Institute for Clinical Evaluative Sciences (ICES) and in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital.

The annual test strip quantity limits are: 3,000 for patients using insulin, 400 for patients on specific oral antidiabetic drugs that are known to increase the risk for low blood glucose, and 200 for all other patients with diabetes.

“This is a great example of a policy change based on evidence, where the change not only saved the province money but had no negative impact on patients. Those healthcare dollars are now available to support other programs and therapies that could improve patient outcomes,” says Gomes.

However, the researchers stress that this study assessed outcomes for only 1.5 years following the implementation of the 2013 policy, adding long-term consequences need to be studied.

“Association of a blood glucose test strip quantity-limit policy with patient outcomes: a population-based study” was published today in the JAMA Internal Medicine.

Author block: Gomes T, Martins D, Tadrous M, Paterson JM, Shah BR, Tu JV, Juurlink DN, Chu A, Mamdani MM.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario.

About St. Michael’s Hospital – St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Center, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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