Why is it GPs don't advise home- testing?

[Sharron1]

Hi,

I am sure this has been asked before but I just wonder why some GPs are adamant that home-testing shouldn't be done. My GP was very anti it. I don't understand why, especially as my experience of advice was so woeful. If I did not ignore her advice I wouldn't have a clue what was going on, especially as my next appointment for review is Feb 2019. I can only think that in part it is it to do with money? The news yesterday noted an increase in young children being diagnosed T2, what sort of advice will they and their families be given?😱😱😱

 

[Pine Marten]

I'm sure it's financial - my GP used to say, straight after praising my efforts, 'you don't need to test'. How on earth did she think I managed any sort of control??

I asked her once about it and she said the NHS didn't allow her to offer meters or advise testing. Pffft.

 

[Northerner]

Hi,

I am sure this has been asked before but I just wonder why some GPs are adamant that home-testing shouldn't be done. My GP was very anti it. I don't understand why, especially as my experience of advice was so woeful. If I did not ignore her advice I wouldn't have a clue what was going on, especially as my next appointment for review is Feb 2019. I can only think that in part it is it to do with money? The news yesterday noted an increase in young children being diagnosed T2, what sort of advice will they and their families be given?😱😱😱

Yes, the chief answer is cost - the test strips are expensive and many healthcare professionals see them as a way to save money on their budgets. They get an additional 'saving' because they don't have to spend time explaining and supporting people so that they understand what the numbers mean and how to improve them. This is all very short-termist, as we all know that if people don't really understand their diabetes and how to tailor their diet to their tolerances (as in eat to your meter') then the likelihood is that they will simply progress on to greater and greater levels of medication and greatly increase their risks of far more expensive complications

There was also some research ages ago that purported to show that people would become depressed at seeing high numbers - but this would only be true if they weren't given the education and resources to improve those numbers! 🙄

Not all HCPs are quite so blinkered, but unfortunately a lot are. Often, they are surprised when someone turns up with a great HbA1c and it is a revelation to them when the person explains that they have achieved it through self-monitoring! To me it's irrefutable logic - how can you know what food choices are poor ones for you, as an individual, if you remain unaware of their impact? How can you solve a problem of an increase in HbA1c when you are unable to see what may be responsible for it? It's not rocket science. Much is spoken about the huge 'strain' on the NHS budget because of diabetes, but what they very rarely point out is that something like 80% is spent on the treatment of complications, and around 80% of those are thought to be avoidable Bad economics and short-sightedness

 

[Kenworthy]

Hi,

I am sure this has been asked before but I just wonder why some GPs are adamant that home-testing shouldn't be done. My GP was very anti it. I don't understand why, especially as my experience of advice was so woeful. If I did not ignore her advice I wouldn't have a clue what was going on, especially as my next appointment for review is Feb 2019. I can only think that in part it is it to do with money? The news yesterday noted an increase in young children being diagnosed T2, what sort of advice will they and their families be given?😱😱😱

 

[Eddy Edson]

I get a slightly different perspective from a buddy of mine who is Dean of a medical school & part of a relevant working group with the Oz college of GP's. Simply put: there are no high-quality studies which show that self-testing is beneficial for T2's, and several which show that it isn't. And it's not like these studies are ancient. Self-testing costs health systems a lot & the funds can be deployed for other things with better evidence. He makes the point that the majority (just) of T2's achieve acceptable (not ideal) HbA1c levels without it.

If studies could be designed and executed which showed evidence of statistically significant better clinical outcomes from self-testing for well-identified subgroups of T2's, he would support it. But well-designed, credible studies studies do not exist at the moment.

FWIW, I've looked at studies which people claim show the opposite, and I agree they look pretty weak. Really, better studies are needed, not just anecdotal support from people like me & us. That's the way evidence based medicine works.

And frankly I have to admit that just in my case, without really knowing what I was doing I did actually bring my BG down to what I think most GP's would see as acceptable levels before I started really to self-test.

 

[Bruce Stephens]

I can only think that in part it is it to do with money?

Also effectiveness, I think. If it looks like self-testing costs money, doesn't improve HbA1c, doesn't make patients feel better, then recommending against it seems like a good idea.

The Cochrane review now does note some subgroups (newly diagnosed, I think) that do look like they benefit, and presumably that'll feed through to general guidance: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005060.pub3/full?highlightAbstract=

I agree the finding is a bit surprising. I wonder whether the kind of person that wants to do self-testing (to expand their diet, for example) might benefit in measurable ways.

 

[Sharron1]

Yes, the chief answer is cost - the test strips are expensive and many healthcare professionals see them as a way to save money on their budgets. They get an additional 'saving' because they don't have to spend time explaining and supporting people so that they understand what the numbers mean and how to improve them. This is all very short-termist, as we all know that if people don't really understand their diabetes and how to tailor their diet to their tolerances (as in eat to your meter') then the likelihood is that they will simply progress on to greater and greater levels of medication and greatly increase their risks of far more expensive complications

There was also some research ages ago that purported to show that people would become depressed at seeing high numbers - but this would only be true if they weren't given the education and resources to improve those numbers! 🙄

Not all HCPs are quite so blinkered, but unfortunately a lot are. Often, they are surprised when someone turns up with a great HbA1c and it is a revelation to them when the person explains that they have achieved it through self-monitoring! To me it's irrefutable logic - how can you know what food choices are poor ones for you, as an individual, if you remain unaware of their impact? How can you solve a problem of an increase in HbA1c when you are unable to see what may be responsible for it? It's not rocket science. Much is spoken about the huge 'strain' on the NHS budget because of diabetes, but what they very rarely point out is that something like 80% is spent on the treatment of complications, and around 80% of those are thought to be avoidable Bad economics and short-sightedness

I did wonder and can only agree with your post.🙄🙄🙄

 

[Sharron1]

I'm sure it's financial - my GP used to say, straight after praising my efforts, 'you don't need to test'. How on earth did she think I managed any sort of control??

I asked her once about it and she said the NHS didn't allow her to offer meters or advise testing. Pffft.

Perhaps she thought you would be able to 'read' your blood simply by looking at it🙄

 

[becca19962014]

In my case I was told because it can cause unecessary distress for people because people don't understand how and when to test properly and it's "pointless" on metformin anyway.

Cost didn't factor as I said I'd pay for my own equipment.

The metformin comment as someone who has had hypos on it is concerning to me. Had I followed the advice I was given and not bought the monitor id have been in a great deal of trouble and fast - the day I started metformin and the diet and checked my BG I was getting readings of 3.0 and 4.0. It was much better for me to test and gradually change things and do it my own way. There's no reason why type 2 can't learn what is appropriate BG reading and when to do it.

 

[Ljc]

Sometime ago I remember reading I believe on here that some research was done on T2s self testing . The way it was set up seemed to me that it up to prove that it self testing didn’t improve BG levels, ie people were told not to change their diets and I think but am not sure some were not told the best times to test.

 

[Lilian]

I had a doctor who said, if you go down the motorway you have to look at speedometer now and again to make sure you are within the speed limit. Therefore to test is like the speedometer.

 

[mikeyB]

The worrying thing about the whole farrago is the we on this forum are a self selected group out of millions at risk of, or living with T2 Diabetes, and I assume they have been given the shabby advice on diet that folk on this forum put right. The same applies to testing.

Is it any wonder that that majority of amputations are a consequence of diabetes, and diabetes is becoming one of the commonest causes of blindness?

 

[Bruce Stephens]

The way it was set up seemed to me that it up to prove that it self testing didn’t improve BG levels, ie people were told not to change their diets and I think but am not sure some were not told the best times to test.

That would surely produce a negative result! That doesn't seem to be the case for the trials included in Cochrane's review. (I don't think, anyway. They say "It is hypothesized that patients with type 2 diabetes who are not using insulin might use the glucose values to adjust their diet and 'lifestyle'.".)

I'd agree that the apparent result (that there's marginal value on average) seems surprising. But it might still be true.

 

[Ljc]

That would surely produce a negative result! That doesn't seem to be the case for the trials included in Cochrane's review. (I don't think, anyway. They say "It is hypothesized that patients with type 2 diabetes who are not using insulin might use the glucose values to adjust their diet and 'lifestyle'.".)

I'd agree that the apparent result (that there's marginal value on average) seems surprising. But it might still be true.

Yes I really believe that research I mentioned was set up to prove self testing did not help.
I can’t remember any other details

 

[Amigo]

‘Eating by the meter’ was the only way I sorted this. Without home testing, I’d have constantly convinced myself it was ok, I’d never know and I’d just make a special effort for the Hba1c test (which is annual for me).

I’ve never yet heard a medic say ‘don’t test your blood pressure or take your temperature because it will only worry you!’.

It’s a financial decision and I know testing isn’t for everyone. They’re brewing up trouble however refusing to work in partnership with those of us who don’t want to be future drains on the NHS.

 

[Northerner]

Yes I really believe that research I mentioned was set up to prove self testing did not help.
I can’t remember any other details

I think this was the research:

https://www.bmj.com/content/344/bmj.e486

(see the conclusion)

 

[Sharron1]

It took me two weeks to decide to home testing, the monitor and stuff remained in the cupboard while I avoided them. Too nervous. But in the end I got on with it and I am so pleased I did.It told me all the info there is no way I could have worked out. Like others I now test randomly. What bothered me is the lack of information/advice offered and only the terrible things that might happen if you don't manage diabetes 😱.

 

[JMyrtle]

Well at my second blood test when I asked if I should be self testing "Nursery" said no.
At the next blood test I said I know you told me not to test but I'm doing it anyway and showed her the excel sheet with my reducing readings.
Oh said I'm so glad you are testing it's practice policy to tell you not to test but I'm type two myself and I definitely test myself.
Now you have made the decision yourself I can take this ( the spreadsheet) show it to doctor and scan it into your notes.
By the way is everyone else sick and tired of the " red tops" opening every report on d/ type 2 with caused by obesity and bad diet, I was neither obese or had a bad diet, sometimes **** just happens!

 

[KARNAK]

The worrying thing about the whole farrago is the we on this forum are a self selected group out of millions at risk of, or living with T2 Diabetes, and I assume they have been given the shabby advice on diet that folk on this forum put right. The same applies to testing.

Is it any wonder that that majority of amputations are a consequence of diabetes, and diabetes is becoming one of the commonest causes of blindness?

I recently attended the Hope Program, I was the only T1 there except for the facilitators, all the others were T2. Some form of disease affected them all especially feet problems except one poor man whose arms wouldn`t be out of place in a leper colony. I didn`t realise how debilitating a T2 can be, lack of knowledge. I came away from the program with a different insight into how D affects us individually, T1, T2, T3C, MODY, LADA, whatever, support for each and everyone of us is key especially from people in a similar/same position. We are all meeting up on December 01st for breakfast on Paignton seafront, will it be croissants or full English? Me thinks I will have croissants with bacon, eggs, mushrooms, beans, plum tomatoes, hash browns and a double bolus, I feel fat already 🙂.

 

[JMyrtle]

That I suppose is the one possible advantage of being type 1!
Think of us poor souls with type 2 having to control with diet and Metformin, basically anything nice is off limits, I could live without the hash browns but croissants and doughnuts, sigh.