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Comment & Response
June 2017

More Rigorous Study Needed Before Claiming No Harm of Blood Glucose Test Strip Limits for Patients Using Insulin—Reply

Author Affiliations
  • 1St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
  • 2Sunnybrook Health Sciences Centre, Department of Medicine, Toronto, Ontario, Canada
  • 3St Michael's Hospital, Applied Health Research Centre, Toronto, Ontario, Canada
JAMA Intern Med. 2017;177(6):890-891. doi:10.1001/jamainternmed.2017.1089

In Reply We thank Dr Witteman for her comments and appreciate the opportunity to provide some perspective. Dr Witteman suggests our analyses are incomplete because we do not report outcomes among high–test strip users receiving insulin. To clarify, we excluded this group because of its extremely small size. Our previous work1 showed that only 0.3% of insulin users 65 years and older exceeded the 3000 test strip limit threshold in the year preceding Ontario’s new policy, rendering robust analysis of changes in outcomes in this population impossible. We replicated this analysis among publicly funded insulin users of all ages, and the results were generally consistent, with 0.6% of users exceeding these limits prior to the policy coming into place. Therefore, the sample size issue described by Dr Witteman is simply driven by the fact that use of test strips in quantities outside of this policy was exceptionally rare among insulin-treated patients before its implementation. Moreover, the policy allows people to access additional strips in any clinically appropriate circumstance (eg, during pregnancy) using a simple pharmacy override code.2,3 We suggest that other jurisdictions considering such a policy review the policy documents cited in our article,1 which outline these details. Moreover, we support expanded communication of these policy details to help ensure that the small subset of patients requiring additional strips obtain them easily.

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