Sign up to all DiabetesontheNet journals
Journals
Sign up to all DiabetesontheNet journals
By clicking ‘Subscribe’, you are agreeing that DiabetesontheNet.com are able to email you periodic newsletters. You may unsubscribe from these at any time. Your info is safe with us and we will never sell or trade your details. For information please review our Privacy Policy.
Are you a healthcare professional? This website is for healthcare professionals only. To continue, please confirm that you are a healthcare professional below.
We use cookies responsibly to ensure that we give you the best experience on our website. If you continue without changing your browser settings, we’ll assume that you are happy to receive all cookies on this website. Read about how we use cookies.
Diabetes &
Primary Care
Issue:
Vol:15 | No:05
Self-monitoring of blood glucose in type 2 diabetes: Let’s not forget the benefits before limiting access to strips on cost
Click here to access full PDF
In recent weeks I have heard a number of anecdotes on restricting access to self-monitoring of blood glucose (SMBG) testing strips in type 2 diabetes.
But what about those who use bolus calculating meters? What about the size of the screen? Can all see it? What about those who may be only able to use one hand? I have people with type 2 diabetes who fit all those categories and deserve to be able to test if they take action on the results.
If that is all tablets it will include sulphonylureas, which can cause hypos (Barnett et al, 2013). On the other hand, I can find no evidence to support one pot of strips per month. The Driver and Vehicle Licensing Agency (DVLA, 2013) advises drivers who could be at risk of hypos to check their blood glucose levels prior to driving and on longer journeys (over 2 hours).
This flies in the face of NICE (2009), which clearly states: “Offer self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education. Discuss its purpose and agree how it should be interpreted and acted upon.”
I received no reply when I asked to see the evidence supporting these moves, so I can only deduce that simply saving money is the aim rather than ensuring cost-effectiveness or that a suitable patient education programme is in place before offering broader access.
Controversy exists regarding the effectiveness of SMBG in type 2 diabetes. On the one hand, it is seen as an expensive option with little evidence to support it; on the other, it is seen as a vital tool in engaging people with diabetes in their own care. Readers would be well advised to peruse previous articles that have discussed available research and practicalities before limiting access to testing strips on the grounds of cost (Martin et al, 2006; Peel and Lawton, 2007; O’Kane et al, 2008; Simon et al, 2008; Farmer et al, 2009; Parkin et al, 2011; Hall, 2012; Downie, 2013).
The now-disbanded NHS Diabetes pointed out the following back in 2010 (NHS Diabetes, 2010):
“There is increasing concern that health service managers and GPs are using published evidence to prevent even individuals who find blood glucose monitoring useful from checking their blood glucose whenever they feel they need to.”
Of potentially greater concern still, the NHS felt earlier this year that GPs (among other professional groups) had to be reminded even in the case of people with type 1 diabetes (Hillson et al, 2013). This is especially worrying in regard to drivers on any medications associated with hypoglycaemia. The updated DVLA (2013) guidance on driving and blood glucose monitoring makes that clear.
Involving the person with diabetes in setting self-monitoring goals and targets should be the norm. And remember: the cost of treating diabetes complications far outweighs the cost of the strips when used effectively.
Barnett AH et al (2013) Curr Med Res Opin 6 Sep [Epub ahead of print]
Downie P (2013) Practical aspects of capillary blood glucose monitoring: A simple guide for primary care. Diabetes & Primary Care 15: 149–153
Driver and Vehicle Licensing Agency (2013) At a glance guide to the current medical standards of fitness to drive. DVLA, Swansea
Farmer AJ et al (2009) Health Technol Assess 13: iii–iv, ix–xi, 1–50
Hall G (2012) Effective self-monitoring of blood glucose. Diabetes & Primary Care 14: 235–40
Hillson R et al (2013) Safe care of people with type 1 diabetes (letter to healthcare professionals). Department of Health, London. Available at: http://bit.ly/Zl6lmP (accessed 24.09.13)
Martin S et al (2006) Diabetologia 49: 271–8
NHS Diabetes (2010) Self monitoring of blood glucose in non-insulin-treated type 2 diabetes. NHS Diabetes, Newcastle Upon Tyne
NICE (2009) Type 2 diabetes – newer agents (CG87). NICE, London
O’Kane MJ et al (2008) BMJ 336: 1174–7
Parkin C et al (2011) Clinical Diabetes 29: 131–8
Peel ED, Lawton J (2007) BMJ 335: 493
Simon J et al (2008) BMJ 336: 1177–80
Prescribing pearls: A guide to pioglitazone
Diabetes Distilled: Diabetes remission in the real world
Hypertension case finding and treatment to target as part of the NHS diabetes eye screening programme
Q&A: Lipid management – Part 3: Triglycerides and use of non-statin drugs
Diabetes Distilled: Impact of metformin timing on glucose and GLP-1 response
Diabetes Distilled: Diabetes-related foot ulcers – detailed advice for primary care
Conference over coffee: Diabetes and obesity within multiple long-term conditions
Understanding pioglitazone: The essential information in one place.
3 Sep 2024
Early data from the NHS Type 2 Diabetes Path to Remission programme show it is effective in achieving remission at scale outside of clinical trials.
3 Sep 2024
A pathway offering opportunistic blood pressure checks during eye screening to support hypertension case finding and follow-up.
29 Aug 2024
Claire Davies answers questions on triglycerides and non-statin drugs.
22 Aug 2024