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Disparities/Minority Health

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Providing free blood glucose monitors to patients with diabetes initially encourages self-management, especially among blacks

Insurance coverage of patient self-management devices like self-monitoring blood glucose (SMBG) equipment may help to reduce race-related barriers to effective care. For instance, a new study found that black patients with diabetes were as likely as white patients to initiate SMBG before insurers provided free home blood glucose monitors. Following implementation of the coverage policy, blacks were 33 percent more likely than whites to monitor their blood glucose levels; yet blacks who began SMBG following coverage of blood glucose monitors were also more likely than whites to discontinue SMBG over time. After 18 months, 78 percent of blacks and 64 percent of whites had stopped self-monitoring their blood glucose levels.

Given the worse outcomes and higher economic and social costs of diabetes among minorities, these findings are promising. However, the low sustainability of monitoring in both racial groups indicates that additional interventions are necessary to improve adherence and clinical outcomes, suggest the researchers. For instance, SMBG is critical for patients to maintain control of blood sugar levels and avoid complications such as vision, kidney, and wound healing problems. SMBG can also indicate when patients need to intensify their medication to maintain better glucose control.

The study findings were based on use of electronic medical record data from 1992 to 1996 to examine racial differences in rates of initiation of SMBG after coverage and rates of discontinuation 18 months after initiation among 2,275 black and white patients with diabetes who were enrolled in a large health maintenance organization (HMO). Socioeconomic differences between black and white patients were relatively small, and all patients were taking oral diabetes medications only. The study was funded in part by the Agency for Healthcare Research and Quality (HS10063).

More details are in "Racial differences in impact of coverage on diabetes self-monitoring in a health maintenance organization," by Connie A. Mah, M.S., Stephen B. Soumerai, Sc.D., Alyce S. Adams, Ph.D., and Dennis Ross-Degnan, Sc.D., in the May 2006 Medical Care 44(5), pp. 392-397.

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