Test strips restriction sends wrong diabetes message, Australia

A government decision to restrict access to blood glucose self-monitoring testing strips sends the wrong message to people with non-insulin-dependent type 2 diabetes (T2D), say the authors of a Perspective published in the Medical Journal of Australia.

On 29 May this year, the Australian federal government announced that access to testing strips for self- monitoring of blood glucose (SMBG) would be limited to 100 strips per year for people with T2D "who are not using insulin and who have their blood glucose level under control".

The decision is based upon an three-year review process and on two systematic reviews which concluded that "clinical benefit is limited" for SMBG in people with non-insulin-treated T2D. It is similar to a Choosing Wisely Australia / RACGP recommendation - "Don't advocate routine self-monitoring of blood glucose for people with type 2 diabetes who are on oral medication only".

However, Professor Jane Speight, foundation director of the Australian Centre for Behavioural Research in Diabetes, and her coauthors wrote that the way SMBG is conducted is vital to its efficacy as a method for improving the health of people with T2D.

The authors wrote that "random, low frequency, routine SMBG" is "unstructured" and "ineffective because it does not enable people with T2D or health professionals to detect blood glucose level patterns or act upon them". "Indeed, people with non-insulin-treated T2D reported that their GPs rarely refer to their glucose diary data, and perceive this to mean that SMBG is worthless. They experience SMBG as 'frustrating', 'painful', 'inconvenient' and 'expensive', they lack motivation for it, and report 'feelings of failure or anxiety in response to high blood glucose readings'."

However, they wrote, when SMBG is "structured" (e.g. seven checks per day over 3 consecutive days in the week before consultation with a doctor) the findings are more positive - reduced glycated haemoglobin (HbA1c) levels, less glycaemic variability overall, less time spent in hyperglycaemia. Furthermore, it also improves the person's confidence in diabetes self-care and can reduce emotional distress.

"Restricting access to glucose monitoring strips conveys the wrong message philosophically", the authors concluded. "At face value, it implies that some forms of diabetes require less monitoring and are, therefore, less serious than others. Yet all diabetes is serious and all diabetes leads to complications if not monitored and managed appropriately."