Self-monitoring of blood glucose before and after Medicare expansion among Medicare beneficiaries with diabetes who do not use insulin.

Abstract

The Balanced Budget Act of 1997 authorized Medicare to expand the coverage of glucose monitors and strips to non-insulin users with diabetes and self-management training to non-hospital-based programs. We examined the impact of this expansion on self-monitoring of blood glucose among Medicare beneficiaries who were not using insulin to treat their diabetes. With data from the 1996-2000 Behavioral Risk Factor Surveillance System and a logistic regression model using a complex survey design, we compared the probability of self-monitoring of blood glucose among Medicare beneficiaries at the frequency recommended by the American Academy of Family Physicians' clinical guidelines before and after the Medicare expansion. We also compared the change in the frequency of self-monitoring of blood glucose during these periods between Medicare beneficiaries and persons with private insurance by using a difference-in-difference model. Medicare expansion was positively associated with the probability of self-monitoring of blood glucose for both Medicare beneficiaries and persons with private insurance; the magnitude was between 7.1 and 16.6 percentage points. The Medicare expansion effectively increased the frequency of the recommended self-monitoring of blood glucose in the Medicare population.