Oregon Moves to Dramatically Reduce Test Strip Access for People with Type 2 Diabetes
At a recent meeting of Oregon’s Health Evidence Review Commission (HERC), the state panel recommended reducing access to test strips for people with type 2 diabetes on the Medicaid-funded Oregon Health Plan (OHP). This was seriously depressing. Currently, the OHP provides 100 test strips every 90 days, but a new plan would severely restrict access to strips for type 2 patients unless they are newly diagnosed, take insulin, or meet a few other special requirements. For people not taking insulin – which covers the vast majority, about 70% of all type 2 patients – those with an A1c above 8.0% would be entitled to one test strip per week, while those with an A1c below 8.0% would not be provided with any test strips at all. This cutoff makes little sense, as most diabetes experts would not consider an A1c of 8.0% to represent good control – that usually starts at 7.0% and lower. It’s difficult to understand how the HERC imagines people with an A1c below 8.0% will maintain or improve that level of control without test strips – they would essentially be punished for managing their diabetes.
As certified diabetes educator and registered nurse Judy Fry notes in an editorial sharply criticizing this recommendation in Portland Business Journal, there is little functional difference between providing one strip per week and none at all, since one weekly data point is hardly meaningful for patients or providers. A test strip is a compass, pointing the way toward better control, and it’s impossible to improve if you don’t know where you are starting or can’t see results of changes in eating, exercise, etc. HERC’s new recommendation would set a dangerous precedent for other states looking to cut overall health care costs. It seems short-sighted since any cost reductions from the recommendation will likely be more than canceled out in the long run by increased complications, hospital visits, and operations that inevitably follow poor control.
The decision is currently scheduled for December 5, and some big questions have yet to be answered: How many people in Oregon will this affect? How much money will it save short-term? How much will it cost long-term? How will the recommendation be enforced and how can patients be exempted because of special cases? If you are a person with diabetes or a caregiver, we encourage you to write to Oregon Health Authority’s Director Dr. Bruce Goldberg and the members of the HERC about the importance of having access to test strips and self-monitoring blood glucose.
The recommendation reflects a broader controversy on whether glucose testing is beneficial for type 2 patients who do not take insulin. Data from studies are mixed, though many, including diaTribe, believe it is due to poor study design. Studies like this are sometimes randomized controlled trials – some believe this is “gold standard” while others believe that these studies usually don’t reflect “real life”. The studies also generally focus primarily on A1c results; we don’t think, especially in the recent age of accurate CGM, that A1c is sufficient as a sole outcome. Glucose testing is a tool, not a therapy, and the results are only useful if they are used to make changes to in medication, eating plan, or lifestyle. Studies like the STeP study do show a benefit to glucose testing for type 2 patients, and the key is actively incorporating educational components to encourage use of the glucose data. –NL/AW/AB/KC
On December 5, Oregon’s Health Evidence Review Commission (HERC) voted on a revised proposal on reduced access to test strips for people with type 2 diabetes. The new proposal will now provide 50 test strips to newly diagnosed type 2 patients, and then 50 strips for every 90 days if the patient starts using a diabetes medication. Although this is not optimal, it is certainly much better than having no strips for people with an A1c under 8.0% and only one strip per week for those with an A1c over 8.0%. We want to thank all of the diabetes advocates who made their voices heard and the more than 3,000 supporters who signed our petition against the original proposal.
The new proposal also includes a “safety valve” for special cases, in which patients can receive 50 more strips if there is a change in glycemic control or adjustments in medication. While it’s encouraging that the commission responded to the public outcry against limiting test strips, we were shocked by the attitude of several commission members. We heard some say, “More knowledge for patients is not always better…”, “Lay people just don’t understand these issues…”, and “We make guidance based on evidence, not emotions…” Even though the revised proposal avoided the worst-case scenario, these quotes underscored a profound misunderstanding of the daily realities of diabetes management.
With the creation of The diaTribe Foundation, we hope to work more on these issues and advocate on behalf of all people with diabetes. diaTribe’s Managing Editor, Nancy Liu, testified at the meeting on behalf of all patients, and reflecting the more than 1,000 comments made on our petition. We’ll publish more details on the Oregon meeting as well as a full version of diaTribe’s testimonial soon… please stay tuned! -NL