Differences in self-monitored, blood glucose test strip utilization by therapy for type 2 diabetes mellitus
Acta Diabetol
Differences in self-monitored, blood glucose test strip utilization by therapy for type 2 diabetes mellitus
Ruben Tavares 0 1 2 3 4 5 6
Marc Duclos 0 1 2 3 4 5 6
Marie-Jose´e Brabant 0 1 2 3 4 5 6
Daniella Checchin 0 1 2 3 4 5 6
Nevzeta Bosnic 0 1 2 3 4 5 6
Katherine Turvey 0 1 2 3 4 5 6
Jorge Alfonso Ross Terres 0 1 2 3 4 5 6
0 GlaxoSmithKline , 7333 Mississauga Road North, Mississauga, ON L5N 6L4 , Canada
1 & Ruben Tavares
2 Managed by Massimo Porta
3 GlaxoSmithKline, King of Prussia , Philadelphia, PA , USA
4 IMS Brogan, a unit of IMS Health , Mississauga, ON , Canada
5 IMS Brogan, a unit of IMS Health , Ottawa, ON , Canada
6 IMS Brogan, a unit of IMS Health , Kirkland, QC , Canada
Aims To determine whether blood glucose test strip (BGTS) utilization in patients with type 2 diabetes (T2D) is associated with the type of diabetes therapy, classified according to hypoglycemic risk. Methods A retrospective, longitudinal (2006-2012) study of Canadian private drug plans (PDP) and Ontario Public Drug Programs (OPDP) prescription claims was conducted. Analyses were restricted to patients with T2D with or without a claim for BGTS. Daily BGTS utilization (TS/patient/day) was evaluated by diabetes therapy classified by hypoglycemic risk. Multivariate analyses were conducted to identify determinants of BGTS utilization. Results The T2D cohort comprised 5,759,591 observations from 1,949,129 claimants. Mean BGTS utilization was 0.84 TS/patient/day and differed between PDP and OPDP (0.66 vs. 1.00). Daily utilization was greatest in patients receiving therapy associated with a pre-defined high risk of hypoglycemia [insulin: basal ? bolus (2.16), premixed (1.65), basal (1.16), other insulin regimens (2.13), and sulfonylureas (0.74)] versus non-sulfonylurea non-insulin-based regimens (0.52). For non-insulin therapy, BGTS utilization was greater for patients on multiple non-insulin therapies versus monotherapy (0.74 vs. 0.53 TS/patient/day). In multivariate analyses, drivers for BGTS utilization included insulin use, previous BGTS use, and female gender. Previous diabetes therapy and duration of therapy were negatively correlated with BGTS utilization. Conclusions BGTS utilization varies depending on the type of therapy used to treat T2D according to hypoglycemic risk. Decision making regarding BGTS needs to account for robust analyses of current utilization and its value in those settings, including in patients not receiving diabetes therapy and the prevalence of circumstances conducive to more intensive monitoring.
Blood glucose self-monitoring diabetes mellitus; Utilization
Introduction
National and international clinical practice guidelines for
the management of diabetes currently recommend
individualized self-monitoring of blood glucose (SMBG) based
on several factors, such as the patient’s type of diabetes and
diabetes therapy regimen [
1–7
]. While patients with type 1
diabetes (T1D) require insulin, patients with type 2
diabetes (T2D) may manage their disease with diet, exercise,
and a variety of treatments (e.g., non-insulin-based therapy,
and insulin) [
1–7
]. SMBG allows for the detection of
hyperglycemia and hypoglycemia to inform disease
management [
2, 3
]. Compared with insulin, the risk of
hypoglycemia associated with non-insulin therapies is lower and
is generally limited to secretagogues [
2, 3, 8, 9
].
Given the cost of blood glucose test strips (BGTSs), the
increasing global prevalence of T2D and the availability of
new diabetes therapies with lower risk of hypoglycemia,
there is considerable interest in ensuring the appropriate
use of SMBG in patients with T2D. However,
internationally, patient-reported BGTS utilization varies markedly
[
10
]. Also, costs per test strip (TS) vary from $0.35
(Australia) to $3.11 (India) (adjusted to US dollar
purchasing power, 2006) [
10
]. Recently, BGTS represented
the third largest expenditure for the public drug formulary
in Ontario, Canada [
10, 11
]. To economize SMBG, in
2009, the Canadian Agency for Drugs and Technologies in
Health (CADTH) recommended limiting BGTS use to
insulin-dependent and gestational diabetes while
withdrawing it from most patients with T2D on non-insulin
diabetes therapy or no therapy [12]. The CADTH
recommendations were criticized by the Canadian Diabetes
Association (CDA) for undervaluing the merits of
selfmanagement in non-insulin-treated patients and for not
accounting for the increased risk of hypoglycemia
associated with secretagogues [
13
]. Notably, Gomes et al.
observed a 33 % increase in daily BGTS utilization for
non-insulin therapies associated with hypoglycemia versus
those not associated with hypoglycemia [
14
].
Despite this, important questions persist. There are
limited data on differences in SMBG across specific
regimens associated with differential hypoglycemic risk.
Additionally, the prevalence and value of SMBG in
patients with T2D not treated with a pharmacologic agent
are not w (...truncated)