The impact of free medical supplies and regular telephonic contact on glycemic control in Indian children and adolescents with type 1 diabetes.

BACKGROUND/OBJECTIVE: The effect of economic assistance to underprivileged families with type 1 diabetes has never been described. Such a study is relevant as logistic and cultural factors may preclude an anticipated good outcome. The objective of the study is to determine the impact of economic and educational intervention on hemoglobin A1c (HbA1c) and diabetes knowledge. METHODS: Eighty-five consecutive participants were prospectively provided insulin and glucose strips for 1 year. From the 6th to 12th month, patients were randomized such that half of them (telephone group) received proactive telephonic advice by a diabetes educator, while the non-telephone group received usual care. HbA1c and diabetes knowledge were measured at baseline, 6 and 12 months. RESULTS: Significant improvement was seen in HbA1c with provision of free diabetes supplies, when patients were compared with their own HbA1c values during the prior 36 months (baseline [8.38 ± 2.0%], at 3 months [8.0 ± 1.6%] and at 6 months [8.1 ± 1.5%, P = 0.0106]). Knowledge score increased from baseline (48 ± 15) to 6 months (58 ± 13, P < 0.001). No difference was seen between the telephone and non-telephone groups in HbA1c from the 6th to 9th and 12th month. The knowledge score showed significant improvement in the telephone group during the proactive telephonic advice study compared with the non-telephone group (P = 0.002). CONCLUSIONS: The provision of free medical supplies improved HbA1c and diabetes knowledge. Intensive telephone contact improved knowledge, not HbA1c. These results provide important background for policy makers and diabetes management teams.

Transitioning to a national (New Zealand) sole supply scheme for glucose meters: lessons learned, problems yet to be solved.

This case study describes the clinical impact of moving to a single brand of glucose test strips. In 2013 the New Zealand public health system completed a move to procure test strips at a significant discount. The associated direct savings is estimated at around 40% of the total glucose strip budget. Half the local diabetes population undertake glucose monitoring using government-funded diabetes supplies. These patients no longer have a choice of brand of meters and strips. Although the majority of patients adapted well to this change, a small percentage did not. Also, some consumers expressed concerns about analytical performance of the new strips, when used in everyday life. A pragmatic postmarketing surveillance system, designed with consumer input, may help address these residual concerns.

Legal and regulatory challenges currently facing diabetes treatment providers and related durable medical equipment suppliers.

It has been estimated that 24 million Americans have diabetes, many of whom are Medicare beneficiaries. These individuals carefully monitor their blood glucose levels primarily through the use of in-home blood glucose testing kits. Although the test is relatively simple, the cumulative expense of providing glucose test strips and lancets to patients is ever increasing, both to the Medicare program and to uninsured individuals who must pay out-of-pocket for these testing supplies. This article discusses the diabetes durable medical equipment (DME) coverage under Part B Medicare, the establishment and role of DME Medicare administrative contractors, and national and local coverage requirements for diabetes DME suppliers. This article also discusses the federal government's ongoing concerns regarding the improper billing of diabetes testing supplies. To protect the Medicare Trust Fund, the federal government has contracted with multiple private entities to conduct reviews and audits of questionable Medicare claims. These private sector contractors have conducted unannounced site visits of DME supplier offices, interviewed patients and their families, placed suppliers on prepayment review, and conducted extensive postpayment audits of prior paid Medicare claims. In more egregious administrative cases, Medicare contractors have recommended that problematic providers and/or DME suppliers have their Medicare numbers suspended or, in some instances, revoked. More serious infractions can lead to civil or criminal liability. In the final part of this article, we will examine the future of enforcement efforts by law enforcement and Medicare contractors and the importance of understanding and complying with federal laws when ordering and supplying diabetes testing strips and lancets.

Self-monitoring of blood glucose: guideline application rather than utilization restrictions on testing strips has potential to reduce diabetes healthcare costs in Italy.

BACKGROUND: Self-monitoring of blood glucose (SMBG) is a proven tool to improve glycemic control, even if it might increase direct costs for diabetes management. In Italy, the purchase, prescription rules and responsibilities, and distribution of testing strips per type of patient are managed differently in each of the 20 Italian regions. The Italian scientific societies for diabetes (Società Italiana Diabetologia [SID] and Associazione Medici Diabetologi [AMD]) have issued validated guidelines for SMBG, but not all regions apply them. We investigated whether following SID-AMD guidelines would help decreasing SMBG and diabetes healthcare costs in Italy. MATERIALS AND METHODS: We compared the regions applying and not applying SMBG guidelines for the mean number of testing strips used, number of hospitalizations (with the principal diagnosis of diabetes, excluding diabetes complications), and duration of hospitalization, as indirect measures of SMBG cost. RESULTS: Regions applying the guidelines recorded higher SMBG testing strip utilization than regions not applying guidelines, but they recorded fewer hospitalizations for diabetes (36.2 ± 11.3 vs. 79.9 ± 27.8 hospitalizations per 100,000 inhabitants, P<0.002) and fewer days in the hospital (363 ± 106 vs. 685 ± 194 days of hospitalization for diabetes per 100,000 inhabitants, P<0.002). CONCLUSIONS: Our data suggest that application of guidelines for SMBG prescription and a strict cooperation between health providers and regional health economic deciders were associated with greater utilization of SMBG testing strips. They were also associated with significantly reduced number of hospitalizations and reduced overall duration of hospitalization for patients with diabetes, potentially saving healthcare costs.

Urine reagent strips: an MDA evaluation.

Despite being cheap to buy, the annual UK urine reagent strip bill is more than 4 Pounds million. Nurses need to be aware that each company's test strip works differently. They also need to learn about the external factors that can interfere with tests.