Testing your blood sugar when you don’t need to may be a waste of time, effort, and money.
December 14, 2018
Some people with type 2 diabetes are instructed to test their blood sugar levels on a regular basis, but a new study suggests too many people test more often than necessary. The study, published December 10, 2018, in JAMA Internal Medicine, concludes that millions of dollars may be wasted because of unneeded testing.
âMore is not always better when it comes to medical care. We need to look at what weâre using our healthcare dollars for,â says the first author of the paper, Kevin Platt, MD, an internal medicine resident at the University of Michigan in Ann Arbor.
More than 30 million Americans have diabetes, with 90 to 95 percent of those cases being type 2 diabetes, according to the American Diabetes Association. But only some of those people need to test their glucose at home.
âTesting is generally recommended for patients on insulin or medications that affect blood sugar levels,â he says. âWe also consider it for a short period of time if youâre titrating medication or doing some type of intensive lifestyle modifications.â
Home testing is typically not needed for patients taking oral medications, such as Glucophage (metformin), he says. Instead of home testing, doctors typically order a blood test, called a hemoglobin A1C test, every three to six months. âThe A1C test gives you a three-month average of what your blood sugar has been, and thatâs what weâll use to make medication changes,â he says.
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Dr. Platt decided to look at the frequency of home testing after noticing that some patients who didnât need to test kept precise notes on their daily blood sugar measurements over long periods of time. The researchers, including senior author A. Mark Fendrick, MD, a professor in general medicine at the University of Michigan, reviewed national insurance data from 370,740 people with type 2 diabetes. They reviewed data from January 1, 2013, to June 30, 2015 â after several medical societies issued guidelines to curb unnecessary home glucose testing. The data reflected patients with private insurance or Medicare Advantage plans who were not taking insulin and who filled prescriptions for packets containing 90 test strips three or more times a year. This pattern of prescribing suggests the patients were monitoring their blood sugar levels regularly.
The study found that 14 percent of people (1 in 7) who likely didnât need to perform glucose monitoring were using an average of two test strips a day.
âWe were pretty surprised at how prevalent this was,â Platt says. âWe also found that almost 25 percent of people were filling at least three prescriptions for at least 90 strips â which is 180 strips in a given year. These were not people who were checking their blood sugar for a month or so. This was regular usage over a period of time.â
While testing doesnât harm these people physically, it does waste precious healthcare dollars, he says. âThe claim cost to insurance companies was a median of $325 per person, per year, which is maybe not that much on a small scale, but when you extrapolate the large number of people doing this it has big effects on the system.â
Research over the past decade has provided strong evidence that home glucose testing is not of value for many patients, says Guillermo E. Umpierrez, MD, a professor of medicine at Emory University and the section head of diabetes and endocrinology at Grady Health System in Atlanta. Dr. Umpierrez was not involved in the study. About 80 percent of people with type 2 diabetes take metformin or other medications not associated with daily fluctuations in blood sugar levels, he says.
âThe benefit of home glucose monitoring has been found to be of questionable significance in several studies during the past decade,â Umpierrez says. âIn patients with type 2 diabetes when not taking insulin, the use of home glucose monitoring has very little impact on improving glycemic control. Several other studies have shown the same thing.â
Three medical societies â the American Academy of Family Physicians,Â the Society of General Internal Medicine, and the Endocrine Society â have all issued guidance on home glucose testing. Those recommendations were based on a 2012 study by the Cochrane Database System Review that 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 sugar drops too low) between patients who do not self-monitor multiple times a day and those who do.
The guidelines are reflected in the Choosing Wisely initiative, an effort to reduce wasteful healthcare spending.
Doctors and patients should consider the downside of unnecessary testing, Umpierrez says.
âUnfortunately, many doctors request patients do frequent testing to assess glycemic control. Itâs unnecessary. Itâs costly. Itâs painful. There is even some data that suggests it may reduce quality of life.â
The new study, says Platt, âshould raise awareness for patients, pharmacists, and providers about: Is this a necessary service for my patients? Sit down and have the conversation. Patients shouldnât be afraid to ask the doctor, âHey, why am I checking my sugars so often?ââ