What is the recommended prescription for a patient with diabetes to monitor their glucose levels daily?

Prescription for Glucose Test Strips in Diabetes Management

For patients with diabetes requiring daily glucose monitoring, prescribe 6-10 test strips per day for those on intensive insulin regimens (multiple daily injections or insulin pump therapy) and 1-3 test strips per day for those on basal insulin or oral medications. 1

Prescription Recommendations Based on Treatment Regimen

For Patients on Intensive Insulin Therapy:

• Quantity: 6-10 test strips daily (180-300 strips per month)
• Timing: Test before meals and snacks, at bedtime, occasionally postprandially, before exercise, when hypoglycemia is suspected, after treating hypoglycemia until normoglycemic, and before critical tasks like driving 1
• Rationale: In patients with type 1 diabetes, increased BGM frequency correlates with lower A1C (0.2% reduction per additional check per day) and fewer acute complications 1

For Patients on Basal Insulin and/or Oral Agents:

• Quantity: 1-3 test strips daily (30-90 strips per month)
• Timing: Focus on fasting glucose measurements to inform dose adjustments 1
• Rationale: Evidence shows that for patients using basal insulin, assessing fasting glucose with BGM to inform dose adjustments results in lower A1C 1

For Non-Insulin Users:

• Quantity: Individualized based on need, typically 1 strip daily or less
• Timing: Strategic testing to assess impact of diet, physical activity, and medication
• Rationale: While routine monitoring may have limited additional clinical benefit in this group, it can provide insight into the impact of lifestyle and medication changes 1

Quality and Safety Considerations

1. Meter Accuracy:

   • Prescribe only FDA-cleared meters with proven accuracy 1
   • Be aware that substantial variation exists in the accuracy of widely used BGM systems 1
   • Only 6 of the top 18 glucose meters met accuracy standards in one analysis 1

2. Strip Quality:

   • Only prescribe unopened and unexpired vials of glucose test strips 1
   • Advise patients against purchasing or reselling preowned or second-hand test strips 1
   • Counterfeit strips can give incorrect results and should be avoided 1

3. Patient Education:

   • Include instructions for proper technique and interpretation of data 1
   • Ensure regular evaluation of technique, results, and ability to use data to adjust therapy 1
   • Teach patients how to recognize and respond to hypoglycemia 1

Special Considerations

• Pregnancy: More frequent testing may be required, with emphasis on postprandial values 1
• Hypoglycemia risk: Patients with history of severe hypoglycemia or hypoglycemia unawareness may require more frequent testing 1
• Continuous Glucose Monitoring (CGM): Consider as an alternative or supplement to traditional BGM, particularly for patients with type 1 diabetes or those with frequent hypoglycemia 1

Common Pitfalls to Avoid

1. Underprescribing: Studies show that 11% of type 1 and 15% of type 2 diabetes patients on insulin don't claim any test strips, and 15% of type 1 and 28% of type 2 patients use fewer than 1 strip per day 2

2. Assuming all meters are equally accurate: Advise patients to check the Diabetes Technology Society Blood Glucose Monitoring System Surveillance Program for information on meter performance 1

3. Not linking monitoring to action: Ensure patients understand how to use BGM data to adjust food intake, physical activity, or medication to achieve specific goals 1

4. Ignoring environmental factors: Be aware that medications, high-dose vitamin C, and hypoxemia can interfere with glucose meter accuracy 1

By following these evidence-based guidelines for prescribing glucose test strips, you can help patients achieve optimal glycemic control while minimizing the risk of complications.