Testing Blood Glucose and Type 2
Here we go again!
It seems that every few years another group announces that blood glucose (BG) testing strips aren't useful in patients with type 2 diabetes who don't take insulin. Here's the latest.
Naturally, the insurance companies (or in Britain the National Health Service) want evidence for this so they can stop paying for strips.
I've blogged about this before, here, so I won't repeat all the arguments. But here's the bottom line:
Of course testing alone won't make a difference. Patients need to know what to do with the results. If you test and see that your fasting is 400 and you say, "Oh bad me" and then don't change any behaviors, the testing won't matter.
The first time I tried a CGM, my A1c went down almost a whole point. Knowing I was a little on the high side kept me from having a snack I didn't need. Even the study cited above showed an A1c decrease of 0.3 in the first 6 months, although the decrease was reduced with time. If some expensive drug had been shown to have an A1c decrease of 0.3 you can bet your strip prescription that your doctor would have recommended it.
But if the insurance companies would rather deny strips to people with type 2 and pay for amputations and guide dogs and kidney dialysis and bypass operations, I suppose that's their choice.
If they'd mandate diabetes education courses that taught people how to "eat to your meter," they'd save a lot a lot of money in the long run. Not to mention pain and suffering in the patients. But I suppose they don't care about the latter.