Unnecessary Testing Proves Costly for Patients With Type 2 Diabetes

Patients with Type 2 diabetes might be testing their blood sugar too often, potentially costing the healthcare system millions, according to a new study.

Of the more than 370,000 patients, 23.4 percent filled three or more claims for test strips over the year, and more than half of those individuals were deemed to be using the supplies inappropriately, researchers found. A median of two strips were used a day, making the average claims cost for test strips $325.54 per person per year.

In 2013, the unnecessary healthcare cost-buster Choosing Wisely promoted a campaign that recommended patients “avoid routine multiple daily self-glucose monitoring in adults with stable Type 2 diabetes on agents that do not cause hypoglycemia.”

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Kevin D. Platt, M.D., from the University of Michigan Department of Internal Medicine, saw patients who had been logging notebooks for years with multiple daily blood sugar levels. These logs and daily testing were beneficial for patients on insulin or with a type of diabetes that carries a risk of hypoglycemia. But patients taking metformin, the most commonly prescribed blood sugar-lowering medication, were not at risk.

Because of the influx of patients unnecessarily self-monitoring their blood sugar, Platt and his team used patient data to quantify the rate of use and cost of self-monitoring blood glucose supplies that may be used inappropriately, with a focus on test strips — the costliest for regular blood glucose monitoring.

The team used claims data from January 2013 to June 2015 from the de-identified Clinformatics Data-Mart Database (OptumInsight), which included commercial health insurance beneficiaries, to view prescriptions filled, ICD-9 codes, office visits and hospitalizations. Adult patients who were pregnant, had Type 1 diabetes or had a prescription for insulin were excluded from the study. Patients with three or more claims for test strips, which suggested routine use, and those with no claims for strips within the study period were included.

This study just featured a small sample size of patients in the U.S. living with Type 2 diabetes — according to the American Diabetes Association, about 28 million Americans have it. That means that this study only represents 1.32 percent of the Americans with Type 2 diabetes.

And because the study found that one in seven patients are using the test strips inappropriately, that means that about 4.2 million people are spending $325.54 a year, totaling almost $1.4 billion in claims costs each year going toward unnecessary supplies.

Platt suggested that electronic health records (EHR) could potentially be used to limit the number the of test strip prescriptions physicians write for patients. EHRs could be cost-saving by prompting a pop-up advisory before physicians write the script. This may prompt physicians to give the prescription a second thought, especially if they see on the EHR that the patient is only on an oral medication.

“It’s a very effective measure of reminding people when it’s not at the top of your mind,” Platt told Healthcare Analytics News™.

Platt also mentioned that it is important to promote awareness about this issue to physicians, pharmacists and stakeholders.

Savings from this could be put toward more medical services and to improve healthcare systems.

“This would be helpful to the patients and healthcare systems at large,” Platt said. “More is not always better when it comes to medical care.”

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