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Millions of people with type 2 diabetes currently test their blood sugar daily or multiple times a day. A recent study at the University of Michigan found that such frequent monitoring could be a waste of time and create unnecessary worry for millions of patients, for whom a quarterly hemoglobin A1C lab test might be sufficient, according to the report published in JAMA Internal Medicine. The hemoglobin A1C test tells you your average level of blood sugar over the past two to three months. Eliminating daily monitoring, they argue, will result in a substantial healthcare savings for insurance plans.
What the focus on cost savings doesn’t do, however, is acknowledge how blood glucose monitoring can help patients manage their day-to-day blood-sugar levels effectively. For example, when patients check their glucose levels in pairs—say, before and after eating a meal or exercising—they can see how these activities affect their levels and gain insight into what kinds of food and exercise might help or hurt them.
People with type 2 diabetes depend on medical research, either directly or indirectly through their doctors and providers, to guide their treatment decisions. In this case, the recommendation to stop blood glucose monitoring may be putting these patients’ health at risk.
The Benefits of Daily Glucose Testing
Jennifer McKenney, M.D., a fellow at the American Academy of Family Physicians who practices family medicine in Fredonia, KS, agrees that there are some patients who don't need to test daily. “They can rely on an A1C test every three months if they are stable on oral medications that don't carry the risk of hypoglycemia,” she says.
Dr. McKenney has seen clear benefits in frequent glucose monitoring, however, with some of her type 2 diabetes patients, for whom monitoring is an important part of day-to-day diabetes management. Most often, these patients are newly diagnosed, starting a new medication, or finding it difficult to manage their levels through diet and exercise alone.
“I know that when my patients come in with a hemoglobin A1C higher than we want, I suggest they go back to checking their blood sugars regularly,” said Dr. McKenney. “I often see improvement then.” Regular monitoring, she says, also helps her patients feel more in control of their disease.
Whether patients are insulin-using or not, many of them tell her that closely tracking their blood-glucose levels gives them a deeper understanding of how diet, exercise, and medication affect them, which can keep patients accountable. Once they learn how to test themselves regularly, patients can use the information they gather to inform major treatment decisions. Without it, the patient is flying blind.
Healthcare Savings, But at What Cost?
In the current, cost-conscious healthcare environment, with the CDC estimating the annual societal cost of diabetes in the U.S. at $245 billion, a study that promises savings is guaranteed to draw the attention of payers and policymakers. Reports like this one can be and have been used by insurers, including Medicare, to justify limiting coverage for monitoring supplies—adding up to a substantial out-of-pocket cost for patients who want to monitor their levels daily.
Kelly Rawlings, of West Des Moines, IA, monitors eight times a day to manage her diabetes. While that number may seem excessive to some, Rawlings maintains that it’s necessary, adding that “it's recommended in guidelines published by the American Diabetes Association.”
“I don't always need to check that many times—say, on days when I don't drive or do planned exercise,” she says. “But the daily amount is calculated to work for my varying needs.”
Still, even with her doctor’s support, Rawlings has experienced difficulty in getting her testing covered. When her doctor contacted her health plan, “they agreed to provide the particular strips I use,” says Rawlings.
But when she went to fill the prescription, the pharmacist told Rawlings that her plan wouldn’t cover the number of strips the doctor had prescribed. Rawlings disputed the decision, calling and writing her provider and eventually taking to Twitter, where she documented her healthcare team’s efforts to get coverage for her monitoring supplies. Finally, months later, her provider agreed.
“Diabetes self-care isn't ‘set it and forget it,’” Rawlings says. “We're not Crock-Pots. Our bodies change, as do our incomes, teams, and goals.”
Dr. McKenney has also seen the negative impact of denying or limiting blood-glucose test strips for type 2 diabetes patients, especially for those starting new medications. “It inhibits me from helping them understand the effects that certain kinds of foods and exercise have on their blood sugar,” says Dr. McKenney. “They might [get coverage for] testing once a day, but I want to see not only what their levels are [at] fasting but also after meals, especially if they come in with normal fasting blood sugars but their A1C is still high.”
Limiting coverage for blood glucose monitoring is a penny-wise, pound-foolish proposition. It not only interferes with and undermines the patient’s ability to manage their diabetes on a day by day basis, but will also increase the possibility of health complications for the patient. Ironically, that will also mean higher healthcare costs for insurers in the future.