Testing Strips & Meters For Type 2s...

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I’ve been having a look around the world, not just in America, but also France, Germany, Canada, New Zealand and Australia. None recommend blood monitoring of glucose in T2s not on medication that could cause hypoglycaemia. They use studies that show no improvement in HbA1c in those testing to those simply monitored with 3-6 monthly HbA1c and given advice on weight and diet in both cases. It is studies of that sort that informs the NICE position. These are reputable studies, so not easy to argue against.

The population of this forum is self selected, not a true reflection of the total population with diabetes. I’m not sure, with all our experiences on this forum, that we have sufficient clout to argue against the bean counters en masse. Their evidence is strong. Our evidence is nothing more than anecdotal, from the small group of the total membership who are vocal on the forum.

NICE would cheerfully admit our results are better than average, if we could show that, but they can’t accept evidence from a self selected group with a ready formed opinion to affect their judgement.

And I say all that as a supporter of blood testing for all T2s.
 
mikeyB said:
They use studies that show no improvement in HbA1c in those testing to those simply monitored with 3-6 monthly HbA1c and given advice on weight and diet in both cases.
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We're not given the information on diet either. We'd need to compare testers with people left to flounder like we are in England. The design of the study is important. Who and what are you actually testinng.

Though, yes, those studies don't help our case.
 
The problem with selected group studies is just that, they are selected. Even if you selected 50% of type 2's for testing the results could still differ from blanket type 2's self testing trial.
 
The key point I was making on that aspect was self selected groups.
 
I've just read this article published last year...perhaps that explains the position in Europe...and the results of the 'reputable studies'.

Despite the availability of robust evidence demonstrating that lowering glycaemic levels reduces the risks of diabetes-related complications, there has been little improvement in recent years in glycaemic control among individuals with diabetes in Europe and the US. Although widely used, there has been considerable controversy surrounding the role of self-monitoring of blood glucose (SMBG) as a means of achieving glycaemic control. This has resulted in a re-consideration of the prescription of blood glucose strips especially in the current climate of health care cost-containment. Existing clinical recommendations lack specific guidance to patients and health professionals regarding SMBG practice intensity and frequency, particularly for those not treated with insulin. Previous studies of the association between SMBG and glycaemic control found often weak, and sometimes conflicting, evidence. More rigorous longitudinal studies are needed to examine the role of SMBG with special attention to the unique needs of patients using different diabetes treatments, within special clinical sub-populations, and during initiation of SMBG versus its ongoing use. Further understanding of the intensity and frequency of SMBG are also needed to capture variability in glycaemic patterns in order to facilitate more specific guideline development.

I am not aware I or anyone else who responded to this thread... asked or expected any study to be limited to a small self selected group from this forum.
 
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i think what Forum experience shows is that there is a significant population of motivated people diagnosed with type 2, on non-hypoglycaemic meds that (with support and education in using results to inform an individualised diet) can significantly reduce HbA1c and maintain that reduction.

To my mind, this is an easier more strategic option for DUK (and/or forum pressure) than attempting to overturn current NICE guidance. There would need to be quite a shift in evidence (multiple studies) to change the balance of evidence. But the current studies do accept there are those for whom SMBG works.

This seems to be the more immediate line of approach in terms of DUK applying pressure for test strips for T2 on D&E to me.

I stress it is not meant to offend. I am merely trying to help and offer ideas.
 
Bubbsie said:
I am not aware I or anyone else who responded to this thread... asked or expected any study to be limited to a small self selected group from this forum.
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That wasn't what @mikeyB was saying, he said that we ARE a self-selected group, which we are.
 
sure @mikeyB can & will explain that himself if he chooses...moreover it would be great to hear anything from DUK directly...particularly how they feel they should/could/would respond to this issue...or would that just be too much to hope for?...coincidentally one of the doctors involved in the report is from my old Alma Mater...South Bank ...be great to explore his views on this the next time I'm in London.
 
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Bubbsie said:
moreover it would be great to hear anything from DUK directly...particularly how they feel they should/could/would respond to this issue...or would that just be too much to hope for?
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I am sure DUK staff who are members of the forum will be keen to comment on the additional posts on this thread after it had gone quiet late on Friday. Most likely once the office opens on Monday, or whenever they are next in and/or allotted forum time. The DUK staff who are members of the forum also have many other responsibilities, as I’m sure you can appreciate.
 
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When I was diagnosed T2 I was prescribed Metformin and told to lose weight by following NHS dietary advice...which is carb heavy. I was also told that T2 diabetes was a progressive condition and that in time I was likely to require more robust medication. This was only a couple of years ago. I have used a combination of education and testing to bring my diabetes under control.

As a result of the new work being done around the world the NHS will inevitably change its approach to diabetes. However, institutions/professionals are resistant to change and in the meantime T2 diabetics are being badly served. The very least they should expect is the opportunity to take control of their own health. Nothing worth having has ever been achieved without a fight. We need to raise the profile of this issue until it cannot be ignored. Instead of throwing up obstacles and objections, DUK should draw up a strategy to get it firmly on the agenda and a thorn in the side of every MP and NHS Trust.
 
I wouldn’t disagree with that Marsbar. I don’t know how they expect people like you and Bubbsie to maintain valiant efforts to save money on medication without testing, or T2s saving money on complications.

In Germany, when this policy was announced in 2013 there was a right stramash from Professors, Medical Academics and researchers, and plain old GPs. Made no difference, though.

Protest in this country is hobbled by GPs complying without a word of protest with this edict, and attempting to justify it to patients. When I was a GP there wasn’t a problem prescribing BG testing kit to Type 2s. It’s about money, not clinical care.
 
Marsbartoastie said:
When I was diagnosed T2 I was prescribed Metformin and told to lose weight by following NHS dietary advice...which is carb heavy. I was also told that T2 diabetes was a progressive condition and that in time I was likely to require more robust medication. This was only a couple of years ago. I have used a combination of education and testing to bring my diabetes under control.

As a result of the new work being done around the world the NHS will inevitably change its approach to diabetes. However, institutions/professionals are resistant to change and in the meantime T2 diabetics are being badly served. The very least they should expect is the opportunity to take control of their own health. Nothing worth having has ever been achieved without a fight. We need to raise the profile of this issue until it cannot be ignored. Instead of throwing up obstacles and objections, DUK should draw up a strategy to get it firmly on the agenda and a thorn in the side of every MP and NHS Trust.
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My diagnosis was exactly the same MBT...given medication...the fatalistic advice...no positive outlook for me...three months later told despite reducing my BG from 17.4 to 8.2...had to up the medication to the maximum dose...said I would eventually be at that point anyway... then likely insulin....I resisted that...continued on diet/exercise...education... testing...now I have reduced my medication to the lowest dose...hoping to rely on diet & exercise only as you do after my next review...agree with all you say above...would definitely second that.
 
Marsbartoastie, Bubbsie; you both got more than I did.
 
Marsbartoastie said:
When I was diagnosed T2 I was prescribed Metformin and told to lose weight by following NHS dietary advice...which is carb heavy. I was also told that T2 diabetes was a progressive condition and that in time I was likely to require more robust medication. This was only a couple of years ago. I have used a combination of education and testing to bring my diabetes under control.

As a result of the new work being done around the world the NHS will inevitably change its approach to diabetes. However, institutions/professionals are resistant to change and in the meantime T2 diabetics are being badly served. The very least they should expect is the opportunity to take control of their own health. Nothing worth having has ever been achieved without a fight. We need to raise the profile of this issue until it cannot be ignored. Instead of throwing up obstacles and objections, DUK should draw up a strategy to get it firmly on the agenda and a thorn in the side of every MP and NHS Trust.
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Same here MBT and my diagnosis was only in Sept this year, 28th to be exact. Totally the same experience.
No mention at all of testing, no guidance, no advice. T2 is a chronic progressive condition bla bla bla. Dont eat rice amd mashed potatoes, loose weight.
You leave the the GP's surgery feeling absolutely depressed and resign yourself to being seriously ill and that there is no escape from. I have come to see that this is absolutely untrue from many angles.
Tell people you are T2 and it just doesn't register with them what in fact you have.
Told my Son, reaction, "Ah Ok you will have to stop eating sweets".
Testing and this forum and the people here have shown me a new road map from everthing to eating and testing.
By utilising testing, without any help in how to monitor my levels or actually test by the way other than members on this forum, I have managed to bring my BG levels under control and stablise them.
I have already stated the same as MBT that we need a cohesive strategy involving members and DUK to take the bull by the horns, so as to speak, and profiile publically this issue. I can self fund but that doesn't stop me from being empathetic with my fellows here who find that very difficult. Diabetes in not selective with reference to socio economic groups, it can affect anyone irregardless of where you sit in society.
There must be many who don't have access to forums like this and perhaps even don't know of the existence of this type of communication platform that is a mine of knowledge. Many who don't have or cannot use the internet. How isolated they must feel.
This whole issue and the responses I have seen on this thread raises a questions for me and again his is largely down to my ignorance.
How and who by is DUK funded?
What about accoutablity for their actions?
We should not let this issue fade away and we should keep this thread well and truly alive.
 
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Ralph-YK said:
Marsbartoastie, Bubbsie; you both got more than I did.
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Ralph...I'm sorry to hear that...I'm assuming you mean 'more' in terms of advice...testing strips...education?...that's the whole reason I tried to raise this issue...many are neglected in terms of the right advice...the appropriate medication...support...initially got I little of that...practically nothing...I did attend a course for half a day...it was hopeless...so I 'educated' myself...I read...researched...joined the forum...self funded strips for almost a year...then on a point of principle decided to challenge my GP & the CCG on that...successful...wanted to encourage others to do likewise...it was hard work...not easy...but it was worth it...we should all have the right level of support...access to what we need to manage our diabetes...I am hoping that attitude will change...I would be prepared to support any movement which brings about a more consistent approach to diabetes from diagnosis onwards...the right education...the right dietary advice...testing strips...anything I got was hard won Ralph...that's not a complaint...not a criticism...that's just how it was...I understand not everyone is able to do that...that's why we need to have these discussions...this thread has been discussed to the full...gained a lot of attention...all of it useful...lets hope it can encourage more to get what they need to manage their diabetes.
 
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My experience was good with my DSN who gets very frustrated with NICE guidelines. She has been trying to promote testing for all type 2's for years. But she has never seen anyone 'resolve' (her words) their diabetes like I have, whether they had meters or not. I believe this is down to not being told how to use a meter to your advantage. Whenever I see a GP at my surgery, they have no idea how I managed to lower my HbA1c. Even the specialist diabetes GP was shocked. My brother was prescribed a meter when just on Metformin. He stopped using it because he didn't like seeing high blood sugar levels rather than change his diet. He was given bad dietary advice. Told to eat more fruit, told breakfast cereals are fine for Type 2's & eat plenty of starchy carbs. Even though he has seen my results with my diet, he won't change because he believes the diet his GP told him to follow is correct & my diet will kill me. The education needs to change. Amazingly, he has not yet progressed to insulin, though he is on full tablet meds, In fact his last HbA1c was only 42, which is probably alcohol related as he is a big whiskey drinker. When I did get him to test, he was often over 12 after food, but later would swing the other way & be down in the 3's. This would explain his lower HbA1c, which takes the average. Not a healthy way to live.
 
Something else I must add. When people with Type 2 are told 'it is a progressive condition & it doesn't matter what you do, you will end up on insulin' are they going to do anything to control it themselves? Most people won't bother. They won't see the point. Information like this is dangerous and by reading the newbies thread on here shows that this happens a lot.
 
Mark Parrott said:
Something else I must add. When people with Type 2 are told 'it is a progressive condition & it doesn't matter what you do, you will end up on insulin' are they going to do anything to control it themselves? Most people won't bother. They won't see the point. Information like this is dangerous and by reading the newbies thread on here shows that this happens a lot.
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Completely agree Mark. We know people on the forum who have been successfully managing their diabetes without meds for 10 years. That’s not to say that people who need the support of medication, or insulin have failed in any way - more that it is a lot more complex and varied than ‘inevitably progressive’.

These doom laden proclamations are entirely unhelpful. As are conversations which trivialise the condition IMO, ‘a bit of diabetes, not to worry take these tablets and try not to have so many sweet things...’.

Slightly off-topic, but I don’t want to split the thread as we have kept the conversation intact after it began with Bubbsie’s initial offer of private support.
 
Mark Parrott said:
My experience was good with my DSN who gets very frustrated with NICE guidelines. She has been trying to promote testing for all type 2's for years. But she has never seen anyone 'resolve' (her words) their diabetes like I have, whether they had meters or not. I believe this is down to not being told how to use a meter to your advantage. Whenever I see a GP at my surgery, they have no idea how I managed to lower my HbA1c. Even the specialist diabetes GP was shocked. My brother was prescribed a meter when just on Metformin. He stopped using it because he didn't like seeing high blood sugar levels rather than change his diet. He was given bad dietary advice. Told to eat more fruit, told breakfast cereals are fine for Type 2's & eat plenty of starchy carbs. Even though he has seen my results with my diet, he won't change because he believes the diet his GP told him to follow is correct & my diet will kill me. The education needs to change. Amazingly, he has not yet progressed to insulin, though he is on full tablet meds, In fact his last HbA1c was only 42, which is probably alcohol related as he is a big whiskey drinker. When I did get him to test, he was often over 12 after food, but later would swing the other way & be down in the 3's. This would explain his lower HbA1c, which takes the average. Not a healthy way to live.
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Mark fascinating read...have a friend in very similar circumstances to your brother...diagnosed...given little advice...Metformin to start...the dosage increased regularly due to ever increasing blood sugars...several years later on insulin...was provided with a meter then...did test...but had no idea how to interpret the results...when I asked her why she hadn't addressed the increase in meds...she said she accepted what her DSN told her...when we discussed it...she no idea what an HbA1c test was...we discuss it often now...making a little headway with her...agree with you...education is vital... for testing...how to interpret the results of testing...changing our diet...lifestyle...some firm encouragement to believe we can improve our management...stop the fatalistic attitude...our diabetes does not have to progress...we can manage it with the right guidance & support.
 
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