No Surprise—Cost of Strips Limits Testing

| Oct 1, 2002

Researchers in Canada studying barriers to self-monitoring of blood glucose discovered that—surprise!—people who were given free strips tested more often than those who had to pay for them. An added benefit of more frequent testing was better blood-glucose control.

In a year-long study of 62 people, B.L. Gregoire Nyomba, MD, PhD, and colleagues from the Diabetes Research Group in the Department of Internal Medicine at the University of Manitoba in Winnipeg, Canada, asked people about their barriers to testing. Half of the subjects were given 50 strips initially and told to buy additional strips as needed. The rest received 100 strips per month.

The results?

  • The group that had to pay for strips had a higher dropout rate (48 percent versus 19 percent).
  • Final A1C levels for the group that had to pay for strips averaged 9.9% versus 8.7% for the group that got free strips.
  • Average blood glucose at the end of the study was 252 mg/dl in the group that had to pay for strips versus 205.2 mg/dl in the group that got free strips.
  • Insulin dosage increased from an average of 58.5 units to 75.1 units per day in the group that had to pay for strips, but it remained about the same (52.5 units per day at the beginning of the study versus 52.6 units per day at the end) in the group that got free strips.

"The simple strategy of supplying free strips increased compliance with [self-monitoring of blood glucose] and enhanced diabetes self-management," Dr. Nyomba wrote in a Letter to the Editor in the July 2002 issue of Diabetes Care.

All participants used Glucometer DEX monitors during the study. Bayer and the Canadian Diabetes Association funded the research.

Native Americans Seeing Improvements

Many Native Americans are enjoying better control and a decreased risk of complications, thanks to a grant that allows Indian health facilities to opt for free strips in that population, says Tammy Brown, MPH, RD, BD-ADM, CDE, nutrition consultant for the Indian Health Service (IHS) National Diabetes Program in Albuquerque, New Mexico. The IHS's annual diabetes audit showed improvements in A1Cs as well as a trend in reduction of other markers for complications, Brown reports.

According to figures from the IHS, 15.1 percent of American Indians and Alaska Natives receiving care from IHS have diabetes and, on average, are 2.6 times more likely to have diabetes than non-Hispanic whites of similar age.

"Our beneficiaries get their test strips for free," Brown says. "The physician orders whatever insurance allows."

However, although funding for the Special Diabetes Program for Indians Diabetes Grant Program has increased from $30 million per year since 1998 to $100 million in 2002, Brown notes that the grant will end in 2003. "The tribes are trying to advocate for continued funding," she says.

Falling Between the Cracks

Other populations fall between the cracks. Suzanne Terrell, RN, BSN, CDE, of Quitman, Texas, sees patients who "are not old enough for Medicare and don't qualify for Medicaid. It's a dilemma: If I can't get them to test, I can't get them to maintain control and they get complications."

Terrell begs as many free strips from companies as she can get. "I keep a stash in my office," she says, "but I don't get as many as I used to."

Insurance Companies Impose Limits, Too

Insurance companies can also pose barriers to frequent testing.

"Most of our children have some coverage," observes Paula Jameson, PRNP, MSN, CDE, of Longwood, Florida, who works with young people who have diabetes. However, she adds: "Insurance companies are throwing up roadblocks. It can be overcome, but it's frustrating. One company had a girl send in her logs every month" to make sure she was really testing that frequently. Jameson said the situation lasted for "about three months" and will be re-evaluated in six months.

"[The insurance companies] keep throwing up hoops to jump through until they see we won't give up."

Yvonne Guthrie, RN, BSN, CDE, of Hillsboro, Oregon, also is frustrated by the unwillingness of insurance companies to pay for a sufficient number of test strips.

"People need to test at least four times a day," she argues. "It's frustrating for me to [try to] get information" with infrequent testing.

Guthrie reports that her patients learn to use their strips judiciously. "If their fasting numbers are acceptable, then they can skip that and test with every meal," she says. "I want them to use their heads. If they've not had a particular meal before, they need to test before and after."

She says she can tell which people test frequently by looking at their logs. "My patients with unlimited strips test six to eight times a day and come in with incredible control."

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