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Expert panel says most daily blood-sugar tests unneeded
Province could save millions on test strips
Spare your fingertips, diabetics. The latest research says many type 2 diabetics can live without daily blood-glucose tests — a fact that could save Canada millions in health care costs.
About 50 patients and health care workers met at the Royal Alberta Museum Tuesday night for a panel on blood-glucose tests for diabetes by the Canadian Agency for Drugs and Technologies in Health (CADTH), a government-sponsored non-profit that gives advice on medical technologies.
Doctors have long recommended that diabetics test their blood-glucose levels from one to seven times a day, says Jeffrey Johnson, St. Albert resident, panellist and the Canada research chair in diabetes health outcomes at the University of Alberta. That test involves poking your finger with a needle and using a test strip on the blood.
But a research analysis by CADTH suggests these tests are unnecessary for most type 2 diabetics. “The benefit really isn’t as great as we once thought,” Johnson says. “It doesn’t add much value and [it] makes people feel anxious and helpless.”
Type 2 diabetics who are not on insulin don’t need to do daily blood-glucose tests, according to CADTH. Type 1 diabetics or type 2s on insulin should customize their test regimes to fit their situation.
Many tests, few results
CADTH released its conclusions on blood-glucose tests last year and is touring the nation to discuss them.
Doctors have long touted the benefits of tests, says Johnson, whose research was part of the CADTH review, but did so without any real evidence. “It really started based on what we thought was a good thing.” Researchers didn’t actually study how the tests affected health until a few years ago.
CADTH did a comprehensive research review on the tests and found that they had little effect on patient health, says Ann Colbourne, panellist and member of the review team.
The team found that daily testing had no clinically significant effect on a patient’s average blood sugar levels, added six days to his or her life, and reduced his or her risk of heart attack by just 0.3 per cent. At a dollar per test, Colbourne says, this wasn’t a big effect.
But it made for a big bill: Canadians spent about $330 million on test strips in 2006. The CADTH review suggests Canadians could save $150 million without affecting patient health by eliminating unnecessary tests.
Doctors can’t do much with test results without knowing the behaviours that caused them, says panellist and pharmacist Rick Siemens. You can tell a patient to test their sugars every morning, but you won’t learn much from it without other information. “All it means is you’ve got a leaky finger now.”
Many doctors also forget to tell patients how to influence their sugar levels, causing frustration when those levels seem to change at random. “If you don’t know what to do with those numbers, you’re really not doing yourself any good.”
That stress, plus the pain of poking your finger, means regular tests might do more harm than good for most people, Johnson says. “For most people with type 2 diabetes, the money spent here might not be the best value.”
Don’t toss those kits
That doesn’t mean the tests are useless, Siemens says. Used strategically, before and after a meal for example, or when switching medications, blood-glucose tests can help diabetics learn to control their condition. “I’m still a big proponent of testing, but it has to be done properly.”
The Canadian Diabetes Association disagreed with the review’s conclusions last year in a position paper, saying that regular tests were a valuable way to reduce diabetes-related complications such as hypoglycaemia, or low blood sugar.
About a quarter of Canadians will be at risk of diabetes in the next decade, Colbourne notes, and the health care costs will be great. “We need to be very tactical in terms of how we’re going to use very limited and finite resources.” Diet and exercise are far better at managing blood-glucose levels than regular tests, she adds.
Patients should work with their doctors to figure out how best to use their test strips, Johnson says, while governments should think about diverting cash used for unnecessary tests towards patient education. “We have to ask…what’s the best way to spend our tax dollars?”
The CADTH study is available at www.cadth.ca/smbg.
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