Most people who take insulin for their diabetes and are covered by the U.S. Medicare program appear not to be monitoring their blood glucose levels — either because they weren’t prescribed any form of glucose self-monitoring or because they aren’t using it correctly, according to a new analysis published in the journal Diabetes Technology & Therapeutics.
For people with type 2 diabetes, the health benefits of self-monitoring blood glucose levels — using either traditional “finger-stick” testing or continuous glucose monitoring (CGM) — have been made clear in several studies. While blood glucose self-monitoring has been a standard practice for type 1 diabetes for decades, there has been some debate about in which cases — and how often — people with type 2 diabetes should monitor their glucose levels. One recent study showed that glucose self-monitoring improves long-term blood glucose control in people with type 2 who don’t use insulin — and people who use insulin are widely considered to benefit even more from self-monitoring. Continuous glucose monitoring has also been shown to help reduce hospitalizations in people with either type 1 or type 2 diabetes.
For the latest analysis, researchers used data from Medicare to look at a sample of over 1.3 million people with diabetes who were on intensive insulin therapy between January and December 2018. The researchers divided participants into four groups — those using any form of self-monitoring who were following it as prescribed (26.4% of participants), those using continuous glucose monitoring in particular, those who were prescribed a form of self-monitoring but not using it as prescribed (35.4% of participants), and those for whom no prescription for self-monitoring could be found (38.1% of participants).
Absent, ineffective monitoring linked to more serious health conditions in Medicare beneficiaries
The researchers were interested in comparing these four groups when it came to both the makeup of the groups — such as the role of race and ethnicity in likelihood to self-monitor — and when it came to outcomes like hospitalizations and overall diabetes-related costs. They found that among the 47.4% of participants with a score of at least 2 for having other major health conditions (known as the Charlson Comorbidity Index, or CCI), 74.1% either didn’t follow self-monitoring as prescribed or had no record of such a prescription. When it came to continuous glucose monitoring, the percentage of white participants who were prescribed this form of monitoring and followed it as prescribed (3.7%) was significantly greater than the percentage of Black participants (1.6%) or Hispanic participants (1.3%). Among participants with a CCI score of at least 2, the rate of hospitalizations and overall diabetes-related costs were both higher for Black and Hispanic participants than white participants, regardless of the method of self-monitoring that participants were prescribed.
The researchers concluded that among people with diabetes on Medicare, absent or ineffective self-monitoring was linked to having a larger number of other serious health conditions. They also noted that people of color were less likely to use continuous glucose monitoring despite having Medicare coverage. “New initiatives that promote diabetes self-management education and support services are needed to improve utilization of glucose monitoring within the Medicare diabetes population.” they wrote.
Want to learn more about managing blood glucose? See our “Blood Sugar Chart,” then read “What Is a Normal Blood Sugar Level?” and “Strike the Spike II: How to Manage High Blood Glucose After Meals.”
