Diabetes Metab J.  2018 Feb;42(1):28-42. 10.4093/dmj.2018.42.1.28.

Improvement of Glycosylated Hemoglobin in Patients with Type 2 Diabetes Mellitus under Insulin Treatment by Reimbursement for Self-Monitoring of Blood Glucose

Affiliations
  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. mkmoon@snu.ac.kr
  • 2Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
  • 3Center for Medical Informatics, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.

Abstract

BACKGROUND
In Korea, the costs associated with self-monitoring of blood glucose (SMBG) for patients with type 2 diabetes mellitus (T2DM) under insulin treatment have been reimbursed since November 2015. We investigated whether this new reimbursement program for SMBG has improved the glycemic control in the beneficiaries of this policy.
METHODS
Among all adult T2DM patients with ≥3 months of reimbursement (n=854), subjects without any changes in anti-hyperglycemic agents during the study period were selected. The improvement of glycosylated hemoglobin (HbA1c) was defined as an absolute reduction in HbA1c ≥0.6% or an HbA1c level at follow-up < 7%.
RESULTS
HbA1c levels significantly decreased from 8.5%±1.3% to 8.2%±1.2% during the follow-up (P < 0.001) in all the study subjects (n=409). Among them, 35.5% (n=145) showed a significant improvement in HbA1c. Subjects covered under the Medical Aid system showed a higher prevalence of improvement in HbA1c than those with medical insurance (52.2% vs. 33.3%, respectively, P=0.012). In the improvement group, the baseline HbA1c (P < 0.001), fasting C-peptide (P=0.016), and daily dose of insulin/body weight (P=0.024) showed significant negative correlations with the degree of HbA1c change. Multivariate analysis showed that subjects in the Medical Aid system were about 2.5-fold more likely to improve in HbA1c compared to those with medical insurance (odds ratio, 2.459; 95% confidence interval, 1.138 to 5.314; P=0.022).
CONCLUSION
The reimbursement for SMBG resulted in a significant improvement in HbA1c in T2DM subjects using insulin, which was more prominent in subjects with poor glucose control at baseline or covered under the Medical Aid system.

Keyword

Blood glucose self-monitoring; Diabetes mellitus, type 2; Hemoglobin A, glycosylated; Insurance, health, reimbursement

MeSH Terms

Adult
Blood Glucose Self-Monitoring
Blood Glucose*
C-Peptide
Diabetes Mellitus, Type 2*
Fasting
Follow-Up Studies
Glucose
Hemoglobin A, Glycosylated*
Humans
Insulin*
Insurance
Insurance, Health, Reimbursement
Korea
Multivariate Analysis
Prevalence
Blood Glucose
C-Peptide
Glucose
Hemoglobin A, Glycosylated
Insulin

Figure

  • Fig. 1 The change in HbA1c during the follow-up periods. Comparisons of the glycosylated hemoglobin (HbA1c) levels at baseline and 3 and 6 months after the first reimbursement for self-monitoring of blood glucose as determined by the paired t-test. All data are expressed as mean±SEM. aP<0.05 vs. baseline, bP<0.05 vs. 3 months.


Cited by  1 articles

Self-Monitoring of Blood Glucose in Patients with Insulin-Treated Type 2 Diabetes Mellitus
Kyung-Soo Kim
Diabetes Metab J. 2018;42(1):26-27.    doi: 10.4093/dmj.2018.42.1.26.


Reference

1. Polonsky WH, Fisher L, Schikman CH, Hinnen DA, Parkin CG, Jelsovsky Z, Petersen B, Schweitzer M, Wagner RS. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study. Diabetes Care. 2011; 34:262–267. PMID: 21270183.
2. Franciosi M, Pellegrini F, De Berardis G, Belfiglio M, Cavaliere D, Di Nardo B, Greenfield S, Kaplan SH, Sacco M, Tognoni G, Valentini M, Nicolucci A. QuED Study Group. The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies. Diabetes Care. 2001; 24:1870–1877. PMID: 11679449.
3. Miller KM, Beck RW, Bergenstal RM, Goland RS, Haller MJ, McGill JB, Rodriguez H, Simmons JH, Hirsch IB. T1D Exchange Clinic Network. Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A1c levels in T1D exchange clinic registry participants. Diabetes Care. 2013; 36:2009–2014. PMID: 23378621.
Article
4. Diabetes Control and Complications Trial Research Group. Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, Rand L, Siebert C. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329:977–986. PMID: 8366922.
Article
5. Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan DM, Peterson CM. American Diabetes Association. Tests of glycemia in diabetes. Diabetes Care. 2004; 27(Suppl 1):S91–S93. PMID: 14693937.
Article
6. Consensus statement on self-monitoring of blood glucose. Diabetes Care. 1987; 10:95–99. PMID: 3552518.
7. American Diabetes Association. Standards of medical care in diabetes: 2010. Diabetes Care. 2010; 33(Suppl 1):S11–S61. PMID: 20042772.
8. American Diabetes Association. Third-party reimbursement for diabetes care, self-management education, and supplies. Diabetes Care. 2014; 37(Suppl 1):S118–S119. PMID: 24357207.
9. Seong SC, Son MS. 2015 National Health Insurance Statistical Yearbook. Wonju: Health Insurance Review and Assessment Service of Korea;2016.
10. Yki-Jarvinen H, Rosenstock J, Duran-Garcia S, Pinnetti S, Bhattacharya S, Thiemann S, Patel S, Woerle HJ. Effects of adding linagliptin to basal insulin regimen for inadequately controlled type 2 diabetes: a ≥52-week randomized, double-blind study. Diabetes Care. 2013; 36:3875–3881. PMID: 24062327.
11. Hong ES, Khang AR, Yoon JW, Kang SM, Choi SH, Park KS, Jang HC, Shin H, Walford GA, Lim S. Comparison between sitagliptin as add-on therapy to insulin and insulin dose-increase therapy in uncontrolled Korean type 2 diabetes: CSI study. Diabetes Obes Metab. 2012; 14:795–802. PMID: 22443183.
Article
12. Poolsup N, Suksomboon N, Rattanasookchit S. Meta-analysis of the benefits of self-monitoring of blood glucose on glycemic control in type 2 diabetes patients: an update. Diabetes Technol Ther. 2009; 11:775–784. PMID: 20001678.
Article
13. Welschen LM, Bloemendal E, Nijpels G, Dekker JM, Heine RJ, Stalman WA, Bouter LM. Self-monitoring of blood glucose in patients with type 2 diabetes who are not using insulin: a systematic review. Diabetes Care. 2005; 28:1510–1517. PMID: 15920083.
14. Burge MR. Lack of compliance with home blood glucose monitoring predicts hospitalization in diabetes. Diabetes Care. 2001; 24:1502–1503. PMID: 11473098.
Article
15. Rosenstock J, Davies M, Home PD, Larsen J, Koenen C, Schernthaner G. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia. 2008; 51:408–416. PMID: 18204830.
Article
16. Karter AJ, Ackerson LM, Darbinian JA, D'Agostino RB Jr, Ferrara A, Liu J, Selby JV. Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry. Am J Med. 2001; 111:1–9. PMID: 11448654.
Article
17. Simon J, Gray A, Clarke P, Wade A, Neil A, Farmer A. Diabetes Glycaemic Education and Monitoring Trial Group. Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial. BMJ. 2008; 336:1177–1180. PMID: 18420663.
Article
18. O'Kane MJ, Bunting B, Copeland M, Coates VE. ESMON study group. Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial. BMJ. 2008; 336:1174–1177. PMID: 18420662.
19. Farmer A, Wade A, Goyder E, Yudkin P, French D, Craven A, Holman R, Kinmonth AL, Neil A. Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial. BMJ. 2007; 335:132. PMID: 17591623.
Article
20. Czupryniak L, Barkai L, Bolgarska S, Bronisz A, Broz J, Cypryk K, Honka M, Janez A, Krnic M, Lalic N, Martinka E, Rahelic D, Roman G, Tankova T, Varkonyi T, Wolnik B, Zherdova N. Self-monitoring of blood glucose in diabetes: from evidence to clinical reality in Central and Eastern Europe: recommendations from the international Central-Eastern European expert group. Diabetes Technol Ther. 2014; 16:460–475. PMID: 24716890.
21. Ji L, Su Q, Feng B, Shan Z, Hu R, Xing X, Xue Y. Glycemic control and self-monitoring of blood glucose in Chinese patients with type 2 diabetes on insulin: baseline results from the COMPASS study. Diabetes Res Clin Pract. 2016; 112:82–87. PMID: 26775249.
Article
22. Centers for Medicare & Medicaid Services. Medicare coverage of blood glucose monitors and testing supplies. 2015. cited 2017 Sep 8. Available from: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1008.pdf.
23. Ontario Ministry of Health And Long-Term Care. Blood glucose test strips. cited 2017 Sep 8. Available from: http://www.health.gov.on.ca.
24. The Department of Health, Australian Government. National Diabetes Services Scheme (NDSS) 2016. cited 2017 Sep 8. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pbs-healthpro-supply-ndss.htm.
25. Schaefer E, Schnell G, Sonsalla J. Obtaining reimbursement in France and Italy for new diabetes products. J Diabetes Sci Technol. 2015; 9:156–161. PMID: 25550411.
Article
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