Diabetes Metab J.  2018 Feb;42(1):28-42. 10.4093/dmj.2018.42.1.28.

Improvement of Glycosylated Hemoglobin in Patients with Type 2 Diabetes Mellitus under Insulin Treatment by Reimbursement for Self-Monitoring of Blood Glucose

• Song YS
• Koo BK
• Kim SW
• Yi KH
• Shin K
• Moon MK

• KMID: 2409184
• DOI: http://doi.org/10.4093/dmj.2018.42.1.28

Abstract

BACKGROUND
In Korea, the costs associated with self-monitoring of blood glucose (SMBG) for patients with type 2 diabetes mellitus (T2DM) under insulin treatment have been reimbursed since November 2015. We investigated whether this new reimbursement program for SMBG has improved the glycemic control in the beneficiaries of this policy.
METHODS
Among all adult T2DM patients with ≥3 months of reimbursement (n=854), subjects without any changes in anti-hyperglycemic agents during the study period were selected. The improvement of glycosylated hemoglobin (HbA1c) was defined as an absolute reduction in HbA1c ≥0.6% or an HbA1c level at follow-up < 7%.
RESULTS
HbA1c levels significantly decreased from 8.5%±1.3% to 8.2%±1.2% during the follow-up (P < 0.001) in all the study subjects (n=409). Among them, 35.5% (n=145) showed a significant improvement in HbA1c. Subjects covered under the Medical Aid system showed a higher prevalence of improvement in HbA1c than those with medical insurance (52.2% vs. 33.3%, respectively, P=0.012). In the improvement group, the baseline HbA1c (P < 0.001), fasting C-peptide (P=0.016), and daily dose of insulin/body weight (P=0.024) showed significant negative correlations with the degree of HbA1c change. Multivariate analysis showed that subjects in the Medical Aid system were about 2.5-fold more likely to improve in HbA1c compared to those with medical insurance (odds ratio, 2.459; 95% confidence interval, 1.138 to 5.314; P=0.022).
CONCLUSION
The reimbursement for SMBG resulted in a significant improvement in HbA1c in T2DM subjects using insulin, which was more prominent in subjects with poor glucose control at baseline or covered under the Medical Aid system.

Keyword

Blood glucose self-monitoring; Diabetes mellitus, type 2; Hemoglobin A, glycosylated; Insurance, health, reimbursement

MeSH Terms

Adult
Blood Glucose Self-Monitoring
Blood Glucose*
C-Peptide
Diabetes Mellitus, Type 2*
Fasting
Follow-Up Studies
Glucose
Hemoglobin A, Glycosylated*
Humans
Insulin*
Insurance
Insurance, Health, Reimbursement
Korea
Multivariate Analysis
Prevalence
Blood Glucose
C-Peptide
Glucose
Hemoglobin A, Glycosylated
Insulin

Figure

• 

  Fig. 1 The change in HbA1c during the follow-up periods. Comparisons of the glycosylated hemoglobin (HbA1c) levels at baseline and 3 and 6 months after the first reimbursement for self-monitoring of blood glucose as determined by the paired t-test. All data are expressed as mean±SEM. aP<0.05 vs. baseline, bP<0.05 vs. 3 months.

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