Type 2 testing - NICE clarification...

[tomm181]

Hi All

I am sure someone can help me with this...I know there are plenty of people who have this issue...

My doctor told me this morning that testing my levels frequently is not neccessary and it is against the NICE guidelines that are laid down, which my health authority follows. Is this correct or not I am unsure about what my doctor is telling me...He also tells me that the 3/6 month blood test is good enough. I will not do very much damage if my levels are higher than they should be for the 2-3 months between tests! That scares me - I do not want to do ANY damage to my system...the longer I can hold this desease in check the better!

I have impressed on them how I am new to this and have turned my life around since diagnosis in May - lost nearly 2 stone, excercise 5-6 times a week, eating very sensibly/borining stuff! I have told them that I want to reduce the amout of Metformin that I take from the 2 x 500ml that I take per day at the moment, which he says is a low dose...

I am not sure about this as I have heard that the one thing I should be doing is testing testing testing, even though I 'only' have type 2 at this stage...I would like to ease off a little and relax what I eat, but am nervous as I cannot test to see what effect this has on me.

I was diagnosed in May this year and have been on the course which was very generic, but useful! My level was 20.9 when diagnosed and then in a test done in June it came down to 8.4 which the nurse was very impressed with...

I asked him what I should do if I was not happy with this and I do not agree with the treatment I am getting - he shrugged and said he did not know...I am sure there must be something that can be done...He said they would not change the guidelines just for me!!

There must be a referral body that I can go to or should I request another doctor deal with me in future?

Any advice would be welcomed - if anyone knows who I can complain to or get stroppy with that would be good - i'm good at that when I have a good case!!

Thanks - Tom

 

[everydayupsanddowns]

Erm.... nope! Not against NICE guidelines at all.

The T2 guidelines are currently being reviewed, but until the new ones are published and we know what they say ( and whether they advocate self-testing in motivated patients) what we can do is look at CG66 (http://www.nice.org.uk/nicemedia/pdf/CG66NICEGuideline.pdf):

From the foreword:

Patient centred care
...Management of diabetes typically involves a considerable element of self-care, and advice should, therefore, be aligned with the perceived needs and preferences of people with diabetes...

And then the key section... (my emphasis)

1.4 Self-monitoring of plasma glucose
1.4.1 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.

1.4.2 Self-monitoring of plasma glucose should be available:
• to those on insulin treatment
• to those on oral glucose-lowering medications to provide information on hypoglycaemia
• to assess changes in glucose control resulting from medications and lifestyle changes
• to monitor changes during intercurrent illness
• to ensure safety during activities, including driving.

1.4.3
Assess at least annually and in a structured way:
• self-monitoring skills
• the quality and appropriate frequency of testing
• the use made of the results obtained
• the impact on quality of life
• the continued benefit
• the equipment used.

There is nothing there that prohibits testing in T2s on D&E or Metformin, and positively *requires* SMBG for everyone else.

Your Dr should listen to you and discuss with you reasons for self testing (and how it helps you/how you use the results) and assess how best to use it in *your* case. Then later follow up to make sure that you are still getting benefit from it etc, but this should be done in discussion with you as an individual patient.

In terms of complaints there should be a practice manager to complain to at least. You can also follow up at PCT level and/or with PALS (Patient Advice and Liaison Service)

 

[tomm181]

Thanks

That's brilliant - thanks...do you have any idea when the new NICE policies will be published?

...or are due to be published?

 

[everydayupsanddowns]

Take a look on the NICE website for 'guidelines in development'. Around 2 years I think.

 

[Northerner]

You might find Diabetes UK's position statement on self-monitoring useful reading also, plus they have produced an Advocacy pack relating to getting test strips:

http://www.diabetes.org.uk/Documents/How we help other/Test strips 2011.pdf