Today people who have diabetes can be thankful that the United States doesn't have a single-payer health care system. Based on two Canadian studies released today, most of us could face the prospect that our health insurance would soon cease to cover the cost of testing with blood glucose strips.
The studies both proposed that Canada could save money by cutting benefits to people with type 2 diabetes who are using drugs other than insulin. Last year 63 percent of people with diabetes in the province of Ontario who weren't using insulin used on average 1.29 test strips per day. Although many of us would say that's too little, one of the studies concluded that it's too much.
The Canadian Medical Association Journal CMAJ on December 21 released these studies subject to revision. You can read the full-text of one study at "Blood glucose test strips: options to reduce usage." The full-text of the other new study is at "Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin."
Each article recognizes that those of us who inject insulin have to test regularly to avoid hypos, if for no other reason. All type 1s and about one-fourth of type 2s inject insulin.
But "the benefits of self-monitoring of blood glucose for patients not using insulin are less clear," one of these articles claims. "Many people who self-monitor their blood glucose are at relatively low risk for drug induced hypoglycemia....frequent use of self-monitoring [by non-insulin users] is associated with unfavorable cost effectiveness..."
Those who are at risk of hypos are people taking one of the insulin secretagogues. These are one of the many old sulfonylurea drugs that remain on the market, which I named at "Good Drugs, Bad Drugs," and the rarely-prescribed meglitinides, Prandin and Starlix.
But avoiding hypos is just one of several reasons why we test. One of the new studies gives lip service in passing to these other reasons. They include cutting back on carbohydrates and getting more exercise if our blood glucose level is too high as well as cutting back on our prescribed medication if our level is too low. Regular testing also lets us track our progress.
The new studies focus instead on testing to avoid hypos. "Many people who self-monitor their blood glucose are at relatively low risk for drug-induced hypoglycemia," is the concluding interpretation in one of these studies. As if that were all that testing is good for!
These studies also assume that average is good enough. They assume average knowledge in making use of the benefits of testing. But those of us who use the Internet and websites like this one to bring our diabetes under control have both greater knowledge and more motivation to make good use of the benefits of testing.
Not surprisingly, the researchers of these studies seem to lack real world knowledge of diabetes. One study, however, admits that their review of the seven randomized controlled trials comparing self-monitoring of testing with no self-monitoring "was statistically in favour of self-monitoring." That, they wrote, translated into a reduction in the complications of diabetes.
The studies also accept the typical price of test strips as being fixed. They cost about 70 cents each, according to one of these studies. Yet, as I have written many times, test strips sold for half that price are readily available. Instead of recommending less testing to achieve a more favorable cost-benefit ratio, the Canadian investigators would have served us better by recommending lower cost strips.
Unless we totally control our blood glucose with a very low-carb diet -- where our blood glucose has essentially no ups and downs -- we need to test. Let's hope that they don't take this coverage away from us.