Self-blood glucose monitoring in relation to medical cost: observation study with Utah Medicaid database

Diabetes mellitus is a group of metabolic disorders that has many long-term consequences costing $132 billion annually, a figure that can be improved with proper management. Previous long-term prospective studies have demonstrated that tight glycemic control will prevent and delay the development of subsequent complications. Consequently, the American Diabetes Association (ADA) recommends daily self-monitoring of blood glucose (SMBG) to achieve tight glycemic control, but mot diabetic patients do not practice SMBG. This study examined the association between the number of blood glucose monitoring reagent strips dispensed and the total diabetic medical and pharmacy cost in a Utah Medicaid population. Separate regression models were developed for diabetics treated with insulin and oral antihyperglycemic agents. This study found 7.3% of the patients enrolled in Utah Medicaid practiced SMBG according to the ADA guidelines. In this sample, patients using insulin and receiving a medium to high number of strips were estimated to have 40% - 53% higher medical cost than patients who received no strip during the same year. Level of AMBG, however, did not appear to affect total diabetes-related medical costs in the insulin group. Nevertheless, total diabetes costs trended upwards at the number of strip obtained increased. Similarly, oral patients were estimated to have 54% higher medical costs for adherent level of SMBG and a trend for higher diabetes cost as the number of strips obtained increased. Patients who obtained strips had higher resource utilization even after controlling for Comorbidity, visits and prior year medical costs. It is unlikely that the use of strips causes an increase in health resource utilization, but it is plausible that variables associated with strip use and increased medical costs are not adequately represented in the statistical models. The observation from this study to no support the growing evidence found in commercial market the positive economic impact of strips coverage for SMBG; however, the program does not provide assess for patient to improve self-efficacy and reduce dependency on medical care for control in the long-term. Longer prospective studies should be conducted to determine long-term outcomes in this population.