Frequent self-testing not cost-effective for diabetics not on insulin

Routine self-monitoring of glucose may not be cost-effective for diabetic patients who don't use insulin, according to a new Canadian study.

The study used data from the United Kingdom Prospective Diabetes Study (UKPDS) to calculate the reduction in hemoglobin A_1c (HgA_1c) associated with frequent self-monitoring (seven or more test strips per week). Then researchers compared the costs of testing with the expected improvements in diabetes-related complications, quality-adjusted life-years and health care costs.

The estimated reduction in HgA_1c that resulted from frequent testing was relatively modest at 0.25% (95% CI, 0.15% to 0.36%). The study found that frequent self-monitoring would reduce diabetic complications compared with no self-monitoring, but at a cost of $113,643 per quality-adjusted life-year gained. The authors concluded that at current test strip prices, frequent monitoring does not appear to be an efficient use of health care resources. They noted that less frequent testing (once or twice a week) may be cost-effective.

Another study in the same issue of the Canadian Medical Association Journal analyzed test strip use among diabetic patients 65 and older in Ontario. The study found a 250% increase in test strip use between 1997 and 2008. Almost half of the patients receiving prescriptions for test strips were at low risk of drug-induced hypoglycemia. The authors suggested that modest reductions in the frequency of self-monitoring in these patients could free up resources for other, more evidence-based forms of diabetes care.