Self-monitoring in Type 2 diabetes: a randomized trial of reimbursement policy

Authors

  • J. A. Johnson,

    1. Department of Public Health Sciences, University of Alberta, Fellow, Institute of Health Economics, Department of Medicine, University of Alberta, Fellow, Institute of Health Economics and
    Search for more papers by this author
  • S. R. Majumdar,

    1. Department of Public Health Sciences, University of Alberta, Fellow, Institute of Health Economics, Department of Medicine, University of Alberta, Fellow, Institute of Health Economics and
    Search for more papers by this author
  • S. L. Bowker,

    1. Institute of Health Economics, Edmonton, and
    Search for more papers by this author
  • E. L. Toth,

    1. Department of Public Health Sciences, University of Alberta, Fellow, Institute of Health Economics, Department of Medicine, University of Alberta, Fellow, Institute of Health Economics and
    Search for more papers by this author
  • A. Edwards

    1. Department of Medicine. University of Calgary, Calgary, Alberta, Canada
    Search for more papers by this author

: Jeffrey A. Johnson PhD, Institute of Health Economics, 1200–10405 Jasper Avenue, Edmonton, Alberta, Canada T5J 3 N4. E-mail: jeff.johnson@ualberta.ca

Abstract

Aim  Self-monitoring of blood glucose is often considered a cornerstone of self-care for patients with diabetes. We assessed whether provision of free testing strips would improve glycaemic control in non-insulin-treated Type 2 diabetic patients.

Methods  Adults with Type 2 diabetes, excluding those with private insurance or using insulin, were recruited through community pharmacies and randomized to receive free testing strips for 6 months or not; all patients received similar baseline education and a glucose meter. Primary outcome was change in HbA1c over 6 months.

Results  We randomized 262 patients (131 intervention and 131 control subjects). Mean age was 68.4 years (sd 10.9), 48% were male, mean duration of diabetes was 8.2 years (sd 7.2), 97% used oral glucose-lowering agents and mean baseline HbA1c was 7.4% (sd 1.2). After 6 months, we observed no difference in HbA1c between intervention and control patients, after adjusting for baseline HbA1c[adjusted difference 0.03, 95% confidence interval (CI) −0.16, 0.22; P = 0.78]. A per protocol analysis of study completers (152/262; 60%) yielded similar results. Intervention patients reported testing 0.64 days per week more often than control subjects (95% CI 0.18, 1.10; P = 0.007), although testing was not associated with better glycaemic control (Pearson r = −0.10, P = 0.12).

Conclusions  Reducing financial barriers by providing free testing strips did not improve glycaemic control in patients with Type 2 diabetes not using insulin. Our results question the value of policies that reduce financial barriers to testing supplies in this population.

Ancillary