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Self-monitoring with blood glucose test strips inefficient use of health-care resources (Canada)
Canadian Medical Association Journal ^ | Dec 21, 2009 | Unknown

Posted on 12/21/2009 9:55:22 AM PST by decimon

Routine self-monitoring of blood glucose levels by people with type 2 diabetes who are not taking insulin is an ineffective use of health resources as the modest benefits are outweighed by the significant cost of test strips, suggest 2 studies http://www.cmaj.ca/embargo/cmaj091017.pdf and http://www.cmaj.ca/embargo/cmaj090765.pdf in CMAJ (Canadian Medical Association Journal) www.cmaj.ca .

In Ontario, blood glucose test strips are the third largest cost for the Ontario Public Drug Programs in 2007/08, accounting for $100 million or 3.3% of drug expenditures. Usage of test strips increased by almost 250% from 76,320 people in 1997 to 263,513 people in 2008. Almost 53% of people aged 65 and over with diabetes received diabetes test strips by 2008. Sixty-three per cent of patients not receiving insulin used blood glucose test strips in 2008.

"In light of the overall costs and questionable benefits of blood glucose self-monitoring in many patients, more focused policy decisions regarding test strips have been proposed in several jurisdictions," write Muhammad Mamdani of St. Michael's Hospital in Toronto and coauthors in a study on options to reduce test strip usage. They project that expenditures associated with blood glucose self-monitoring will exceed $1 billion in Canada and suggest policy changes could lead to cost reductions.


TOPICS: Business/Economy; Health/Medicine; Society
KEYWORDS: deathpanels; denialofcare; diabetes; hellthcarefromhell; obamacare; type2diabetes
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1 posted on 12/21/2009 9:55:23 AM PST by decimon
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To: decimon; neverdem; Pharmboy

Stripping ping.


2 posted on 12/21/2009 9:56:15 AM PST by decimon
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To: decimon

Coming soon to a death panel near you.


3 posted on 12/21/2009 9:59:38 AM PST by reg45 (Be calm everyone. The idiot children are in charge!)
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To: decimon

In other news preventative care visits are deemed too costly and only moderately beneficial for some patients.


4 posted on 12/21/2009 10:03:31 AM PST by Domandred (Fdisk, format, and reinstall the entire .gov system. I am Jim Thompson.)
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To: decimon

Well, these are certainly not needed for a significant number of type 2s; however, there are some that would benefit. The decision should be left to doc and patient.


5 posted on 12/21/2009 10:04:39 AM PST by Pharmboy (The Stone Age did not end because they ran out of stones...)
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To: decimon

This self-testing is also done by those who, by dent of their heritage, are concerned about flipping over into type 2 diabetes.

I have a family history of diabetes. But I am not diabetic, just worried about not being overweight (so far, so good) or encountering from some other factor that might bring on diabetes. So, I test myself from time to time.

The commenters are right, though. Big Government Health Care will see this as something to cut in the future.


6 posted on 12/21/2009 10:05:04 AM PST by OldPossum
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To: reg45
Coming soon to a death panel near you.

Likely so.

From the article "Usage of test strips increased by almost 250% from 76,320 people in 1997 to 263,513 people in 2008."

Because there was no or little cost to the strips. First they giveth and then they taketh away.

7 posted on 12/21/2009 10:05:05 AM PST by decimon
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To: reg45
Coming soon to a death panel near you.

And possibly by Christmas.

8 posted on 12/21/2009 10:05:51 AM PST by Alex Murphy
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To: decimon

What a bunch of morons! There are different types of type 2 and one of them is insulin resistant. My body produces insulin but the body fails to efficiently use it. Insulin will do nothing for insulin resistance. Monitoring is important because without it you don’t know if diet and exercise is working and even for those who take insulin you can’t always tell if the insulin dose is effective. Monitoring blood sugar is how I knew that diet and exercise were no longer working well and that I needed to start taking Metformin to regulate blood sugar through liver function. This is what you get when you let bureaucrats run things.


9 posted on 12/21/2009 10:05:51 AM PST by RJS1950 (The democrats are the "enemies foreign and domestic" cited in the federal oath)
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To: decimon

Being a patient in the VA (DAV) system with diabetes, the VA has reduced our strips to, two a week. And yet they tell me to monitor my glucose every day or two times’ per day.

This is part of the HOPE & CHANGE the younger generation has voted for.

I no longer ask God to bless America, I now use, “God Have Mercy On America” !!!!!!!!!!!!


10 posted on 12/21/2009 10:05:51 AM PST by buck61
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To: Pharmboy

Is there an alternate method?


11 posted on 12/21/2009 10:07:15 AM PST by decimon
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To: buck61
Being a patient in the VA (DAV) system with diabetes, the VA has reduced our strips to, two a week. And yet they tell me to monitor my glucose every day or two times’ per day.

Can you buy these on your own? If so then do you know what they cost?

I'm asking because I believe some open competition would probably drive down the price.

12 posted on 12/21/2009 10:10:55 AM PST by decimon
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To: decimon

Coming soon to Amerika...’Merry Christmas’ to all you Type2 diabetics out there across the fruited plain from the Democrat Party and all their supporters! Ho, ho, ho!


13 posted on 12/21/2009 10:14:59 AM PST by who knows what evil? (G-d saved more animals than people on the ark...www.siameserescue.org.)
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To: decimon
Can you buy these on your own? If so then do you know what they cost?

Generally, test strips cost about a dollar a piece. They are actually tiny electronic devices.

14 posted on 12/21/2009 10:15:17 AM PST by Minn (Here is a realistic picture of the prophet: ----> ([: {()
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To: RJS1950
You are in the same boat as my wife. She was(is) type 2 insulin resistant. She had her A1C down to 4.9 at one point two years ago. She had stopped monitoring her blood glucose because she was doing so well and her doctor (worthless doctor I might add, but that's a different story) said she didn't need to monitor anymore, just do the A1C ONCE A YEAR!?

Now it's back up to 7 on the same diet and exercise and she's kicking herself that she wasn't monitoring her glucose levels. Even once a day would have clued her in there might have been a problem.

15 posted on 12/21/2009 10:20:10 AM PST by Domandred (Fdisk, format, and reinstall the entire .gov system. I am Jim Thompson.)
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To: decimon
Is there an alternate method?

When your feet look like this, go to the doctor.


16 posted on 12/21/2009 10:21:18 AM PST by SC DOC
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To: Minn
Generally, test strips cost about a dollar a piece. They are actually tiny electronic devices.

Thanks. I imagine they would come to cost less with increased usage and improved manufacturing techniques. Unless, that is, they are being provided at no cost to the user.

17 posted on 12/21/2009 10:26:11 AM PST by decimon
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To: decimon
I have to pay for my own test strips, so found the Side Kick system at Wally world, cost around $20.00 with 50 strips. I did a month of comparison with the Bayer meter I was using and they were within 2-3 points of each other every time.
18 posted on 12/21/2009 10:28:58 AM PST by sticker
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To: SC DOC

Reminds of the cold weather hazards films they showed us in the Army. That was right before they started making us do all they’d warned us to not do.


19 posted on 12/21/2009 10:30:56 AM PST by decimon
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To: sticker
I have to pay for my own test strips, so found the Side Kick system at Wally world, cost around $20.00 with 50 strips.

Not an insignificant ongoing cost but not either a prohibitive cost for most people.

I did a month of comparison with the Bayer meter I was using and they were within 2-3 points of each other every time.

I take it that's good but I don't know.

20 posted on 12/21/2009 10:36:36 AM PST by decimon
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To: decimon

thanks, bfl


21 posted on 12/21/2009 10:37:17 AM PST by neverdem (Xin loi minh oi)
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To: Domandred

My doctor is a military doctor at a military hospital. She always wants to make sure that I track my blood sugar at a minimum twice a day. She and the other doctors I have had there have been great and leave nothing to chance. I’ve had more poking and prodding since retiring from the military than I ever had on active duty. After a military career and 16 years of retirement from the military I have received nothing but top rate care; same for my family. My hope is that it will continue but that hope is dimming. My wife has her primary provider through our workplace and her secondary is Tricare standard. Her coverage is as much in jeopardy as mine. If it comes to a confrontation I am fully ready to take part because I still hold to my oath to defend the Constitution against the Nazi democrat party.


22 posted on 12/21/2009 11:01:09 AM PST by RJS1950 (The democrats are the "enemies foreign and domestic" cited in the federal oath)
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To: decimon

Guess you’ll need to deteriorate to Type 1 Diabetes in order to get strips.

But the kicker now will be that insulin won’t be covered!


23 posted on 12/21/2009 11:09:42 AM PST by Secret Agent Man (I'd like to tell you, but then I'd have to kill you.)
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To: decimon
Routine self-monitoring of blood glucose levels by people with type 2 diabetes who are not taking insulin is an ineffective use of health resources...

Is it just me, or are others noticing the pattern? Most of the medical news since the Democrats went over the cliff on medical care is about how preventative medicine is a poor use of resources, and we'd be better off without self monitoring of glucose, without mammograms, without pap smears, and without so many other tests that used to be considered essential back in the days when doctors who cared about patient outcomes made medical decisions. Today, with government bean counters in charge of medicine, we're going to get the "change" that Obama promised.

24 posted on 12/21/2009 11:20:39 AM PST by Pollster1 (Natural born citizen of the USA, with the birth certificate to prove it)
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To: decimon; Pharmboy; austinmark; FreedomCalls; IslandJeff; JRochelle; MarMema; Txsleuth; ...
I haven't checked to see if those pdf links are open access.

Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin

Blood glucose test strips: options to reduce usage

Here's the conclusion of the second abstract:

Interpretation: Many people who self-monitor their blood glucose are at relatively low risk for drug-induced hypoglycemia. The economic benefits associated with more selective testing could be redirected to more effective interventions for patients with diabetes.

IMHO, it's probably a reasonable conclusion, but in this atmosphere poisoned by rat duplicity, you can't have a rational discussion.

FReepmail me if you want on or off the diabetes ping list.

25 posted on 12/21/2009 11:25:19 AM PST by neverdem (Xin loi minh oi)
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To: neverdem

Thanks.

Diabetes ping list? I’ll try to keep you in mind if anything interesting comes up.


26 posted on 12/21/2009 11:33:58 AM PST by decimon
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To: decimon

I’ve been doing this for a long time although I am not a diagnosed diabetic. I can find some good deals on ebay of unused strips. Just be sure to find some that are not expired or close to expiration. Another tip: The brand sold by Wal-Mart at a fraction of the price of others also gives very good and accurate results and they are also available on ebay.

I think it is just good insurance to keep from tipping into Type II diabetes as it is so common with obesity. And keeping weight off as we age is no easy task.


27 posted on 12/21/2009 12:26:07 PM PST by RichardW
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To: SC DOC

As the parent of a type 1 diabetic, pictures like those are very difficult to view.


28 posted on 12/21/2009 12:38:18 PM PST by toast
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To: RichardW
I’ve been doing this for a long time although I am not a diagnosed diabetic.

So non-diabetics are using these strips to assess their condition. At their own expense. And competition is indeed keeping down the price. Sounds just right.

29 posted on 12/21/2009 12:45:07 PM PST by decimon
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To: decimon
“Not an insignificant ongoing cost but not either a prohibitive cost for most people”

Most of the Test Strips are $50.00 for 50

“I take it that's good but I don't know”

My doctor didn't seem to have a problem with that variance

30 posted on 12/21/2009 12:53:21 PM PST by sticker
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To: buck61

The test strips are an OTC item. It looks like Moe is attempting to shift costs.


31 posted on 12/21/2009 12:54:28 PM PST by Domangart (editor and publisher)
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To: sticker
My doctor didn't seem to have a problem with that variance

Your doctor didn't have to pay for the strips. I think it would be good for medicine to be more consumer driven.

32 posted on 12/21/2009 12:56:58 PM PST by decimon
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To: Domangart
The test strips are an OTC item. It looks like Moe is attempting to shift costs.

I can buy the strips without a prescription, but with a prescription my insurance picks up half the cost.

33 posted on 12/21/2009 12:57:34 PM PST by nina0113
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To: decimon
Yes, there is an alternative method ~ pay for them yourself.

Unfortunately they are controlled use items so you have to have a prescription. That means seeing a doctor and the doctor is probably going to enforce the "standards of care".

I've heard many doctors are quite susceptible to intimidation so if your doc won't give you a prescription you know what to do.

With 5% of the population having the genes for Type II odds are excellent for you to get a jury with a diabetic on it, so you'll walk.

34 posted on 12/21/2009 1:00:51 PM PST by muawiyah
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To: neverdem

Folks using glipizide and glucophage are at considerable risk of hypoglycemia ~ which makes me think the guy who wrote this article is an idiot and didn’t correctly report what he was told.


35 posted on 12/21/2009 1:07:54 PM PST by muawiyah
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To: muawiyah

I don’t believe it is accurate to say that glucophage increases the chance for hypoglycemia. I don’t know about the other med you mention.

The strips are an OTC item and do not require a prescription nor are they required for the lancets. The kits to measure the glucose levels are available most anywhere OTC or on the internet. I’m not sure about the insulin, however as it might be a prescription item.

To get some idea of the savings available, 50 strips of the Ascencia Contour strip which I use retail for about $57 at Wal-Mart. However, I regularly buy them from ebay for perhaps $15-$20. Alternatively, the house brand at Wal-Mart is considerably less retail but highly accurate as I have compared the result alongside one another. It might vary a point or two. The best test result is with the A1C test but that is more expensive and typically done with the blood work-up at the doctor’s office. For the average patient it is much easier to do the test at home.

Oddly enough, the highest readings are often in the morning and are known as the “Dawn phenomenon” and readings taken two hours later after meals will show perfectly normal. There has been much literature on this subject by many sources. One can read up on this and become educated on the actual facts.

Regardless, diabetes is a serious problem and could lead to early death from cardio problems; strokes and heart attacks and possibly blindness as the retina is affected as it also is with high blood pressure. I keep a VERY close watch on both at my age, 66, to ensure I don’t prematurely wear a toe tag or have to get about with a white cane.


36 posted on 12/21/2009 1:42:07 PM PST by RichardW
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To: muawiyah

I don’t believe it is accurate to say that glucophage increases the chance for hypoglycemia. I don’t know about the other med you mention.

The strips are an OTC item and do not require a prescription nor are they required for the lancets. The kits to measure the glucose levels are available most anywhere OTC or on the internet. I’m not sure about the insulin, however as it might be a prescription item.

To get some idea of the savings available, 50 strips of the Ascencia Contour strip which I use retail for about $57 at Wal-Mart. However, I regularly buy them from ebay for perhaps $15-$20. Alternatively, the house brand at Wal-Mart is considerably less retail but highly accurate as I have compared the result alongside one another. It might vary a point or two. The best test result is with the A1C test but that is more expensive and typically done with the blood work-up at the doctor’s office. For the average patient it is much easier to do the test at home.

Oddly enough, the highest readings are often in the morning and are known as the “Dawn phenomenon” and readings taken two hours later after meals will show perfectly normal. There has been much literature on this subject by many sources. One can read up on this and become educated on the actual facts.

Regardless, diabetes is a serious problem and could lead to early death from cardio problems; strokes and heart attacks and possibly blindness as the retina is affected as it also is with high blood pressure. I keep a VERY close watch on both at my age, 66, to ensure I don’t prematurely wear a toe tag or have to get about with a white cane.


37 posted on 12/21/2009 1:42:27 PM PST by RichardW
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To: RichardW; All

FYI, you can now get home A1C tests cheap from walmart.

http://reli-ona1c.com/Home.aspx


38 posted on 12/21/2009 1:46:37 PM PST by MetaThought
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To: muawiyah
Folks using glipizide and glucophage are at considerable risk of hypoglycemia ~ which makes me think the guy who wrote this article is an idiot and didn’t correctly report what he was told.

The danger with insulin is that with the chance of accidentally injecting into a blood vessel, the first symptom you can have is a loss of consciousness.

Oral agents are much more likely to have prior symptoms like breaking into a cold sweat and feeling light headed before that happened. That can happen with insulin too, but those symptoms are warning signs that can be remedied with adding concentrated sugar in orange juice or soda pop.

39 posted on 12/21/2009 2:14:20 PM PST by neverdem (Xin loi minh oi)
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To: MetaThought

How recent is that Meta? I used to get A1c kits (First Choice?) at WalMart then they disappeared about two years ago. I think they ran about $22 for the monthly test.


40 posted on 12/21/2009 3:49:18 PM PST by Sparky1776
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To: Sparky1776

This is very recent. I saw it the last time I went shopping.

It’s <$10 AFAIK.


41 posted on 12/21/2009 3:54:50 PM PST by MetaThought
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To: MetaThought

I’ll be looking for those Meta, thank you for the tip. I seem to keep on my diet better by checking my A1c monthly - that way I know what my result is going to be before I visit my doc.


42 posted on 12/21/2009 3:59:37 PM PST by Sparky1776
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To: decimon

Years ago those with diabetes had to frequently visit their doctor for testing. The self check strips cut down significantly on doctor visits. I would think the test strips are cheaper than doctor visits. Of course with the new health care plan no one will be able to see the doctor frequently so I guess they will save money. As I see it, if you have diabetes and test strips are not paid for, and you can’t get in to see the doctor regularly to check your glucose then you will likely end up insulin dependendent and of course without proper care you will die sooner. So problem solved, they saved money on you and that is what really counts.


43 posted on 12/21/2009 4:05:36 PM PST by Tammy8 (Please Support & pray for our Troops; they serve us every day. Veterans are heroes not terrorists!)
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To: buck61

Thank you for your service. Hubby is also disabled veteran with diabetes and goes to an Army hospital for care. They have not (yet) limited his strips but the kind he uses are dated and if out of date by even one day will not give a reading. Instead of limiting his strips they give him a lot more than he needs and when they expire they have to be thrown away~ very wasteful. No logic is used with this sort of thing.


44 posted on 12/21/2009 4:12:51 PM PST by Tammy8 (Please Support & pray for our Troops; they serve us every day. Veterans are heroes not terrorists!)
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To: decimon

I don’t know about the strips the VA uses, but hubby gets his strips from an Army hospital and we have tried to buy them elsewhere and no one carries his type of strip. The pharmacists always say no one else has the same type of tester the Army gives patients. In order to buy our own strips we would have to buy a more common type of tester- glucometer or whatever it is called. It is one of the many odd issues with government run healthcare- Army, VA. Coming soon to everyone it seems.


45 posted on 12/21/2009 4:18:00 PM PST by Tammy8 (Please Support & pray for our Troops; they serve us every day. Veterans are heroes not terrorists!)
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To: Pollster1
The dims said they could cut the cost of waste enough to pay for this boondoggle~ seems it is a waste to do preventative medicine, and many patients/treatments will be deemed an ineffective use of health resources more people will die sooner, all saving money of course. It's part of the grand plan don't you know?
46 posted on 12/21/2009 4:24:33 PM PST by Tammy8 (Please Support & pray for our Troops; they serve us every day. Veterans are heroes not terrorists!)
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To: Tammy8
I don’t know about the strips the VA uses, but hubby gets his strips from an Army hospital and we have tried to buy them elsewhere and no one carries his type of strip. The pharmacists always say no one else has the same type of tester the Army gives patients.

There's the right way, the wrong way and the Army way. Or, in this case, the VA way.

47 posted on 12/21/2009 4:31:23 PM PST by decimon
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To: Tammy8

I misread you. It is indeed the Army way. :-)


48 posted on 12/21/2009 4:34:42 PM PST by decimon
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To: decimon

Proves these communists know nothing about free enterprise. When less people buy the strips the price will go up. DUMMIES!


49 posted on 12/21/2009 4:37:46 PM PST by Terry Mross (It's not racist if it's true.)
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To: decimon
That's right, he isn't that’s why I went with this system, IT IS CHEAPER than the options.
50 posted on 12/21/2009 4:56:34 PM PST by sticker
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