Managing change: a Canadian policy study of self-monitoring blood glucose

Self-monitoring of blood glucose has long been a cornerstone of daily diabetes management. Though the clinical benefit of this practice is undisputed for diabetics treated with insulin, evidence to support the benefit of regular blood glucose testing for diabetics not treated with insulin is lacking. Yet provincial drug benefit programs—including the Ontario Public Drug Program—have seen their blood glucose test strip expenditures grow exponentially among this patient group as a result of inefficient use. Using a qualitative research methodology, this study examines the barriers and facilitators to implementing policies that promote optimal use of blood glucose test strips in Canada. My research findings inform the development of policy options for Ontario, which are evaluated against a set of criteria. I find that a staged implementation of policies would be the best approach. I recommend that Ontario proceed with a targeted, multifaceted knowledge transfer initiative, and in the long term, implement careful restriction of reimbursement for blood glucose test strips.