OBJECTIVES: To evaluate the relationship between self-monitoring of blood glucose (SMBG) test strip utilization and medication intensification in Type 2 diabetes mellitus (T2DM). METHODS: A retrospective study of Marketscan data examined patients with T2DM with ≥2 prescription claims or a 90-day supply of at least one non-insulin antihyperglycemic (AH) agent during a 4-month baseline period between July 1, 2006 to December, 31, 2009. The first claim for an AH was the index date. Patients were classified by number and dosage of AH agents, and by their utilization of SMBG test strips during the baseline period. Utilization of AH agents and insulin was assessed during follow-up between months 6-12 post-index. Medication intensification included an increase between baseline and follow-up in the number of AH classes used, an increase in dose, or the addition of insulin. An analysis of medication intensification from baseline to follow-up between users and non-users of SMBG test strips at baseline was conducted using chi-square analysis. RESULTS: Among 824,461 patients selected, 482,854 used one, 258,477 used two, and 83,130 used three AH agents at baseline. SMBG test strip use was observed in 28.3% of the entire population, with 17.0% using >4 test strips weekly. The following treatment changes occurred from baseline to follow-up: no change 67.9%, a decrease in AH classes 13.0%, an increase in AH classes 15.4%, initiating insulin 2.5%, and increasing dose 6.8%. The utilization of SMBG test strips at baseline in patients with no change or a decrease in medication intensification during follow-up was 28.0%, which was significantly different compared to SMBG use in patients with an increase in AH classes (29.1%), patients initiating insulin (32.8%), and in patients increasing dose (30.6%) (all P<0.001). CONCLUSIONS: The use of SMBG test strips is associated with medication intensification among users of AH therapy in T2DM.