Self-monitoring blood glucose test strip use with diabetes medicines in people with types 1 and 2 diabetes in New Zealand.

AIMS

(1) To identify actual dispensings of publicly funded blood glucose test strips (SMBG) in New Zealand according to severity of disease, as proxied by the type of medicines prescribed; and (2) To compare these rates with published consensus guidelines on SMBG usage.

METHOD

All dispensings of diabetes medicines and blood glucose test strips (SMBG) in 2011 were identified and matched to patients, using encrypted National Health Index numbers (NHIs). Five hierarchical treatment groups were identified, as the use of: -Insulins without oral hypoglycaemic agents (OHs); -Insulins with OHs; -Sulphonylurea-containing OH regimens without insulins (with or without other diabetes medicines); -Metformin alone, with or without glitazones or acarbose; and -No diabetes medication but accessing SMBGs. The average SMBG dispensings to patients in each of these groups was then calculated. The calculation was performed only for 'steady-state' patients, i.e. patients assumed stabilised on the same medication regimen for at least one year. Differences between actual and expected dispensings were calculated from expected daily strip use for each group.

RESULTS

An estimated 183,000 patients were dispensed diabetes medicines and/or SMBG during 2011. Of these, 122,000 were identified as 'steady-state' patients. Patient numbers and median ages varied widely across treatment groups and by gender and ethnicity. Dispensing rates for SMBG varied by treatment group, with probable over-dispensing in some groups and under-dispensing in others when compared with published guidelines. In particular there appeared to be relatively large under-dispensing of SMBG in patients requiring insulin (especially the 25-44 age-group or Maori and Pacific peoples) and a high over-dispensing in those using metformin alone or on no diabetic medication.

CONCLUSION

There are appreciable variations in the use of SMBG between treatment groups. Adherence to published guidelines may improve efficacy and health outcomes for those using insulin and reduce pain, anxiety and disruption for those using metformin or diet alone for control of their diabetes.