Self Monitoring of Blood Glucose

Study of Testing Response in Patients with Type 2 diabetes (STRIP-Type 2)

Description

Increased attention on the economic impact of diabetes has been noted in both the popular press and medical journals. One of the most disturbing trends uncovered by the Canadian Diabetes Association’s Diabetes Report Card 2001 is the high cost of diabetes-related supplies that are used in self-monitoring of blood glucose (SMBG). Self-monitoring of blood glucose is considered by many people to be an important part of the self-management of diabetes. This is especially true when self-monitoring is part of a comprehensive education and follow-up program for people with diabetes. However, there is very little research evidence that self-monitoring itself has an important effect on blood sugar control. This is especially true for people with type 2 diabetes. The costs of diabetes testing supplies are not small, and not everyone with diabetes has insurance coverage (public or private) for these supplies. The STRIP-Type 2 study will address the question of whether providing free diabetes testing strips to people with type 2 diabetes will lead to improvements in blood sugar control, or the frequency that they monitor their blood sugars. The results of this research would help the governments decide where to invest health care dollars to obtain the best return on that investment.
There are 2 phases to the study, the first being a cross-sectional survey which serves as not only a screening mechanism for phase 2 of the study, but also is the focus of Chad Mitchell’s MSc thesis work. The cross-sectional survey will be analyzed to assess the relationships between SMBG behaviors, health and glycemic control. Phase 2 of the study is a six month randomized control trial and will involve a subset of the phase one subjects. The primary study outcome would be overall glycemic control, as measured by HbA1c. Secondary outcomes would be self-reported performance of diabetes self-care activities and SMBG testing frequency. Recruitment for this study will take place through a network of pharmacies in Edmonton, Calgary, and Regina. Final results of STRIP-Type 2 are expected in spring of 2003.

Research Team

Jeff Johnson, Ellen Toth, Sumit Majumdar, Chad Mitchell, Samantha Bowker

Funding

Aventis Canada
Institute of Health Economics
Canadian Diabetes Association

Presentation at Canadian Diabetes Association Annual Meeting, October 2006

Dr. Sumit Majumdar presented on the PRO side of a debate on “Frequent Glucose Monitoring is a Waste of Time in the Vast Majority of People with Type-2 Diabetes”.

Dr. Majumdar presented results from our STRIP Study, which was published in the November 2006 issue of Diabetic Medicine.

Papers

Bowker SL, Mitchell CG, Majumdar SR, Toth EL, Johnson JA. Lack of insurance coverage for testing supplies is associated with poorer glycemic control in patients with type 2 diabetes. CMAJ 2004;171(1):39-43.

Mitchell CG, Bowker SL, Majumdar SR, Toth EL, Johnson JA. Lack of correlation between patient-reported outcomes and glycemic control in type 2 diabetes. Can J Diabetes 2004;28(4):362-368.

Johnson JA, Majumdar SR, Bowker SL, Toth EL, Edwards A. Self-monitoring in Type 2 diabetes: A randomized trial of reimbursement policy. Diabetic Medicine 2006;23:1247-1251.

Invited Commentaries