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Testing More Often Leads to Better Control

Feb 15, 2013

Frequent blood sugar testing was strongly associated with better diabetes control….

They concluded that public and private insurers should not be limiting test strip supplies.

Researchers added that, particularly for people with type 1 diabetes, who must test their own blood sugar throughout each day and inject insulin to regulate sugar levels, a cap on the number of test strips they’re allowed to use may seriously affect their health, researchers say.

Medicare currently pays for a maximum of three blood-testing strips daily, and private insurers only slightly more. Those limits have stayed low because the strips were costly, about 60 or 70 cents per strip. But now with the new bidding process in place for Medicare, the cost will be less then 11 cents a strip.

According to the study’s lead author Kellee Miller, a biostatistician at the Jaeb Center for Health Research in Tampa, Florida, and her coauthors, some contend there’s little evidence that more testing translates to better care that would justify paying for more test strips.

So Miller’s team collected data on blood sugar control and frequency of self-testing among more than 20,000 people participating in a registry of type 1 diabetics. About half were under age 18.

The researchers looked at how many times a day participants tested their blood, and also at a marker called hemoglobin A1C.

In all age groups in the study, testing more frequently was linked to safer blood sugar levels, according to the published results. Those who checked three or four times a day, for example, had 8.6 percent A1C, compared to 7.6 percent for people who checked 10 times a day. Testing more than 10 times a day didn’t seem to bring any added benefit.

"One percent for A1C is a huge difference," said Miller. Poor control of blood sugar has short and long term risks, including kidney disease and nerve damage.

Getting extra test strips for patients who need them is a lengthy process involving a lot of paperwork. You have to send in chart notes for any patients requiring more then usual strips.

It is hopeful that future guidelines and the new lower cost will better reflect our current understanding, from this study and others.

Diabetes Care online February 1, 2013