Health Care Costs and Financing

People with diabetes do a better job of managing their disease when HMOs cover diabetes self-monitoring devices

A new study provides preliminary support for efforts by health maintenance organizations (HMOs) and State legislators to cover home testing equipment such as blood glucose monitors and test strips for type 1 (insulin-dependent) and type 2 diabetes (typically treated with insulin and/or sulfonylureas). According to the study findings, when an HMO provided free blood glucose monitors (at a cost of up to $100 each) to people with diabetes, more patients self-monitored their blood glucose (SMBG) which, in turn, increased regular use of diabetes medications and reduced high blood glucose levels.

In the study, which was supported by the Agency for Healthcare Research and Quality (HS10063), Stephen B. Soumerai, Sc.D., of Harvard Medical School, and his colleagues evaluated whether an HMO policy providing free blood glucose monitors increased SMBG. They also examined whether initiating SMBG was associated with increased regularity of diabetes medication use and improved glucose control (lower hemoglobin A1c, HbA1c) among 3,219 people with diabetes in the HMO.

Compared with rates 2 years before policy initiation, SMBG rates 2 years afterwards showed a significant increase in SMBG among insulin-treated patients. Among sulfonylurea-treated patients, the monthly initiation rate of SMBG increased by 14 new patients per 1,000, a doubling of the expected initiation rate.

Test strip use increased 75 percent during the first 6 months after the policy began. Compared with noninitiators of SMBG, initiators showed sudden and significant improvements in regularity of medication use by 6 months after initiation (19.5 fewer mean days between medication dispensing among those with low refill regularity; 9.7 fewer mean days among those with moderate regularity) and in glucose control (0.63 percent lower mean HbA1c level) among those with poor baseline glycemic control (HbA1c greater than 10 percent; 7 percent is considered good glycemic control).

See "Effects of health maintenance organization coverage of self-monitoring devices on diabetes self-care and glycemic control," by Dr. Soumerai, Connie Mah, M.S., Fang Zhang, M.S., and others, in the March 22, 2004, Archives of Internal Medicine 164, pp. 645-652.

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