Same old, same old…

Many of us have had to go through the alleged cost-saving exercise of moving from a patient-centred selection of blood glucose meters to a single option, chosen mainly for the cheaper strip cost. There are many primary care trusts (PCTs) that have followed this process in an attempt to stem the increasing cost that is placed on the prescribing budgets as a consequence of expensive blood glucose test strips. It is not uncommon to find that PCTs are spending more per annum on test strips than they are on oral diabetes medications.

We have been using a single-brand meter for some time now for all patients who are new to testing, but we have been allowed to use other meters with facilities such as carbohydrate counting or ketone testing for people who have been diagnosed with type 1 diabetes. There has been no directive to actively switch people over from their current meter unless the patient chooses to do so. I have yet to see any evidence that money has been saved in our particular PCT, but I know that some other PCTs who have used this same process have increased their expenditure on test strips rather than saving money. It is difficult to assess the real costs here as the number of people with diabetes continues to rise incrementally year on year, with many people with type 2 diabetes requiring insulin therapy at the later stages of their condition.

There are as many papers that support self blood glucose monitoring in type 2 diabetes as those that dispute its benefit. However, it is clear that people with type 1 diabetes need access to blood glucose monitoring in order to self-manage their glycaemic control.

The Department of Health published an open letter on 4 February 2013, which was sent to all healthcare professionals in England, reminding them of the importance of blood glucose testing for people with type 1 diabetes. The letter states that an increasing number of people with type 1 diabetes have been refused prescriptions for sufficient testing strips, owing to their cost. The letter reminds all healthcare professionals that although testing strips are expensive, the wider costs to the NHS of the complications of uncontrolled diabetes far outweigh the cost of testing strips. According to the letter, there are 250 000 people with type 1 diabetes in England, whose lives depend on insulin injections or pump treatment.

The letter also reminds us of the changes within the Driver and Vehicle Licensing Agency (DVLA) guidance in recent years for drivers with insulin-treated diabetes, to ensure that hypoglycaemia whilst driving is reduced to a minimum. At the other end of the blood glucose spectrum, the potentially fatal diabetic ketoacidosis (DKA) is increasing. As we all know, DKA is often precipitated by infection or illness, so it is crucial that people with type 1 diabetes have the appropriate knowledge and equipment, such as blood glucose test strips and ketone testing strips, to be able to minimise the effects of their condition.

The letter concludes that it is essential that people with type 1 diabetes are prescribed sufficient self blood glucose monitoring testing strips for their clinical needs. The provision and use of these strips needs to be in the context of a wider ongoing patient education programme, which encourages people with diabetes to self-manage, including understanding “sick day rules”, recognising the symptoms of DKA, early action and how to seek help, as well as any specific considerations in light of any activities they may carry out, especially if it involves driving. It also states that GPs and pharmacists should work collaboratively with patients to ensure the appropriate amount of testing strips are prescribed and supplied to people with type 1 diabetes. Finally, the letter closes with the following statement: 

“Too few can lead to serious clinical consequences. Too many can lead to wastage.”

It will be interesting to see if this letter has any impact on the rationing of blood glucose test strips in the future – we will just have to wait and see!