OBJECTIVES: To describe the use and cost of blood glucose monitoring test strips (BGMTS) in the first year of treatment with antidiabetes drugs. METHODS: We conducted a population-based cohort study using the Quebec (Canada) Health Insurance Board data. The cohort was made of Quebec inhabitants aged ≥ 18 years, who initiated  an antidiabetes (AD) treatment made of a monotherapy of sulfonylurea, metformin, or insulin between January 1, 2000 and December 31, 2007 and for whom we had at least one year of follow-up in the database. New users were those with no insulin or oral AD claim in the 12 months prior to the first insulin or oral AD dispensing date (treatment initiation). Use and cost of BGMTS during the 365 days following treatment initition were described according to the class of drug initially taken. RESULTS: In this cohort of 116,201 new users of AD drugs the proportion of individuals who had at least one claim for BGMTS was 51%, 58% and 71% among users of sulfonylureas, metformin and insulin, respectively. The mean weekly number of strips used was 3.5, 3.7 and 14.6 among users of sulfonylureas, metformin and insulin, respectively for an associated mean daily cost of $0.45, $0.48 and $1.81. The proportion of individuals on insulin who received ≥14 BGMTS/week was 48%. CONCLUSIONS:  The proportion of individuals on oral AD who obtained BGMTS seems high considering this practice is not recommended. On the other hand it is troublesome that almost the quarter of individuals on insulin did not fill any claim for BGMTS in their first year of treatment. Almost half of individuals on insulin used more tests than the suggested maximum weekly limit of 14. Results suggest there is a need to optimize the use of BGMTS.