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Implementation Project (Limited Competition D&I PFA)
In progress; Recruitment not applicable

Rethink the Strip: Stopping Glucose Monitoring for Non-Insulin Treated Type 2 Diabetes

Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is working to phase out daily blood sugar testing for patients with type 2 diabetes who don’t need insulin, based on a recent study showing that daily testing doesn’t help these patients to manage their diabetes or improve their quality of life.
If you have type 2 diabetes, it’s important to keep the amount of glucose, or sugar, in your blood at a healthy level. People with type 2 diabetes should get an HbA1c test every few months. An A1c test measures average blood sugar levels over the past three months. Many patients also check their blood sugar at home each day. But most patients with type 2 diabetes who don’t need insulin can avoid the discomfort, expense, and time of testing blood sugar each day.

What is the goal of this implementation project?

Many people with diabetes test their blood sugar daily. Testing involves pricking the finger with a small needle, putting a drop of blood on a test strip, and putting the strip inside a hand-held meter that shows the blood’s sugar level. But a PCORI-funded research study found that people with type 2 diabetes who don’t use insulin didn’t benefit from daily self-testing. Based on this and other research, the project team created a program called Re-Think the Strip. The program aims to increase clinician knowledge about daily blood sugar testing and reduce unnecessary self-testing for patients with type 2 diabetes who don’t use insulin. This project is putting Re-Think the Strip in place in several North Carolina clinics.

What will this project do?

The project team is first helping three clinics in North Carolina to adopt Re-Think the Strip. Staff and patients at these sites are providing feedback to help the team revise the program as needed. The project team is then working with 17 more clinics to help them put the program in place.

The Re-Think the Strip program includes:

  • Meetings with a trained nurse practice facilitator at each clinic to discuss the results of the research on daily blood sugar testing, review case studies, conduct role-playing activities, and answer questions
  • Educational webinars for clinicians
  • Educational materials for clinicians and patients
  • Tools for clinicians to support the use of the program, such as user-friendly fact sheets, communication scripts, discussion guides, and frequently asked questions

The project team is also working with IT experts to gather data from health records and other sources to capture trends in prescriptions for daily blood sugar testing for patients with type 2 diabetes at each clinic. Every three months, clinicians receive report cards and feedback based on these data.

What is the expected impact of this project?

This project will demonstrate what’s required for routine use of a program to reduce unnecessary blood sugar self-testing for patients with type 2 diabetes who don’t use insulin.

Twenty primary care clinics are taking part in the Re-Think the Strip program. These clinics serve 4,400 patients with type 2 diabetes who don’t use insulin. The project evaluation will confirm that the program is working as intended.

More about this implementation project:

Stakeholders Involved in This Project*

  • UNC Physicians Network
  • Blue Cross Blue Shield of North Carolina
  • North Carolina Division of Public Health, Community and Clinical Connections for Prevention and Health Branch
  • North Carolina Diabetes Advisory Council
  • National Diabetes Education Program
  • American Association of Diabetes Educators American Diabetes Association
  • Atrium Health

*Stakeholders are engaged as neutral parties; their views about Re-Think the Strip may be positive or negative.

Implementation Strategies

  • Package a group of evidence-based de-adoption strategies into a multi-component program.
  • Use data warehousing techniques to generate provider- and site-specific audit and feedback reports.
  • Provide sites with tools to support implementation, including infographic fact sheets, communication scripts, and FAQs.
  • Provide educational materials to patients, as handouts.
  • Provide education for clinicians, including webinars, lunch-and-learns, and physician bulletins.
  • Use a phased implementation approach, refining the program with a small number of sites and then expanding to remaining sites.
  • Identify and prepare practice champions at sites.
  • Provide clinicians with quarterly audit and feedback report cards.
  • Provide technical assistance to sites, including in-person practice facilitation to review evidence related to daily self-monitoring of blood glucose, discuss de-adoption strategies, conduct role-playing activities, and answer questions.
  • Offer continuing medical educational credit.

Evaluation Outcomes

To document implementation:

  • Number of clinics that agree to adopt the program
  • Number of providers and diabetes educators reached
  • Number of patients with non-insulin treated type 2 diabetes receiving care from a project-trained provider
  • Fidelity
  • Feasibility
  • Acceptability based on surveys and focus groups

To assess healthcare and health outcomes:

  • Clinician knowledge about daily blood sugar testing
  • Clinician attitudes about daily blood sugar testing 
  • Trends in test strip prescriptions over time (both for established and newly diagnosed patients)

Evidence Updates

Blood Sugar Testing to Manage Type 2 Diabetes in Patients Who Don't Need Insulin

More to Explore...

Media Mentions

A Diabetes Home Test Can Be a Waste of Time and Money
Carroll, "The Upshot" Blog, New York Times, March 11, 2019
Blog post author Aaron Carroll, who moderated a 2018 PCORI Annual Meeting plenary session about balancing benefits and potential harms of different treatment options, discusses the related study's finding that routine glucose monitoring may be unnecessary for people with Type 2 diabetes who are not on insulin. Study Principal Investigator Katrina Donahue, MD, MPH, was a presenter/panelist in that session.

Journal Citations

Related Journal Citations

Journal Citation

A Cost Analysis of Rethink the Strip: De-implementing a Low-value Practice in Primary Care

Project Information

Katrina Donahue, MD, MPH
The University of North Carolina at Chapel Hill
$1,926,748
Rethink the Strip: De-adoption of Glucose Monitoring for Non-Insulin Treated Type 2 Diabetes in Primary Care

Key Dates

November 2018
May 2023
2018

Study Registration Information

HSRP20193220

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Does Daily Self-Monitoring of Blood Sugar Levels Improve Blood Sugar Control and Quality of Life for Patients with Type 2 Diabetes Who Do Not Use Insulin? -- The Monitor Trial

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Last updated: January 20, 2023