Is fingerstick testing improving T2D outcomes?

[Oldvatr]

http://news.unchealthcare.org/news/...-test-necessary-for-type-2-diabetes-treatment

I do not agree with this report, but I do have to admit that the majority of T2D I meet and discuss our care with, I am the only one doing regular testing,

 

[carol43]

Giving the participants the correct eating regime would help. Eat to your meter.

 

[Freema]

fingerstick testing makes people know more of what food they can and can not eat ... and that makes people have a better outcome longterm I think, especially if they understand that they need to have an average blood glucose lower than 6.5 mmol to really avoid the most devatating adding conditions... as it is known that when being higher than that level do show much more body-decay and dangerous lifethreatening adding illness infections and nerve damage

 

[leslie10152]

http://news.unchealthcare.org/news/...-test-necessary-for-type-2-diabetes-treatment

I do not agree with this report, but I do have to admit that the majority of T2D I meet and discuss our care with, I am the only one doing regular testing,

I might be a little 'anal retentive', but I cannot see how you can maintain good diabetic control without blood tests?

 

[Phoenix55]

So much depends on what the participants were instructed to do about their diet, their exercise regime and how to use the numbers that the monitors generate. Were they all treated the same? We acknowledge here that we are individuals and that T2 is more like a symptom of a variety of disorders and that the outcome for individuals depends very much on how quickly they were diagnosed and the treatment regime that we were given.

 

[ringi]

Giving the participants the correct eating regime would help. Eat to your meter.

Or just give people good low carb training and get them to read all the food labels.

It seems that people who are from a background where they expect to get access to a lot of data and quickly make changes based on that data, benefit from testing their own BG often, but most people just write the number in the book without taking any action based on it.

Until I see a clinical trail where people took a photo of each item of foot/drink they had, along with before and after BG, and where given weekly support to help them focus on the data, I will not believe the results that claim BG testing is not good for me.

 

[Bluetit1802]

I may be reading it wrong, but the participants were told to only test once daily.

Well, what use is that? Absolutely none. It is meaningless, and clearly the researchers had no idea how to use meters to the best advantage.

The medical profession in charge of Type 2 diabetic patients have no clue about testing out food, before and after, and using the results to discover what they can or can't eat. When I explained to my lovely nurse how I did this she was amazed. She is a senior nurse, specialises in diabetes, and presents our local X-Pert courses. No-one had ever told her about this way of controlling diabetes. It had never been part of her training - and she keeps up with her training.

From what I read on here, those lucky enough to be prescribed strips are told to test maybe once a day after main meal, but aren't told to test before it, and aren't told what levels they should expect to see. To me this is a complete waste of strips, and gives no-one the opportunity to learn.

 

[Oldvatr]

I might be a little 'anal retentive', but I cannot see how you can maintain my experience is that only a small percentage of patiensgood diabetic control without blood tests?

I have to be careful agreeing with you, since you make 2 different points here. The second one about testing is my sentiment entirely. However in my experience the number of people actually interested in being proactive in their care is quite small. We are a priviledged few here on this forum compared to the 3m so far diagnosed in the UK. I think that the NHS not supporting T2D testing regime for non ID has much influence in this, and many are probably not aware that testers are widely available outside the NHS. Anyway, it will eat into their pocket money, so its a bad idea innit? GP's do not promote SMBG and actually try to deter such activity. Many will be put off by the thought of sticking lancets into themselves sickening,

Lots going against SMBG, and reports such as this one do not help at all. It is not the first to draw these conclusions, and it will probably not be the last. Lets face it, successful SMBG leads to reduced meds, and less profit for someone.

 

[Art Of Flowers]

I think a better test would be on those type 2 diabetic patients who actually reduced their HbA1C significantly. My diabetes nurse tells me that most of her patients make very little change to their diet and still add sugar to their tea and eat a lot of high carb junk food. Such people may get depressed by finding their blood sugars are constantly dangerously high, despite the medication. However, for those patients who want to reverse type 2 diabetes, having a glucose meter is a vital tool to help them refine their diet.

When diagnosed my HbA1C was 99 and blood glucose 13. After 5 weeks I had an appointment with the diabetes nurse who gave me a Accu Chek Mobile glucose meter. The first reading was 9.8. I had stopped eating food high in sugar, but not cut out all high carb food. After this I cut out more high carb food such as potatoes, rice and ready brek. A few weeks later my weekly fasting blood sugar levels dropped down to around 6. I think the testing does give you useful feedback to show that you are on the right path.

I replaced ready brek with porridge as I thought this had a lower glycemic index, but I discovered that porridge raided my blood sugars to over 10, so I stopped eating it. Without the glucose meter I would not have known that. Once you have determined which foods are to be avoided the need to test is reduced. I only check now if I am uncertain about eating something new and weekly to see if my blood sugars are on track. I did notice that when I had an injection in my knee that my blood sugars were raised for a couple of weeks. I would not have known that without testing.

I think blood testing is useful for T2 patients, but not essential to do multiple times a day once you have got your fasting blood sugars down to the 4-7 range and you know what is safe to eat.

 

[Dark Horse]

This trial was basically investigating whether giving patients feedback would improve any benefits of once-daily testing:-

Using stakeholder engagement approach, we developed and implemented a pragmatic trial of patient with non-insulin treated T2DM patients from five primary care practices randomized to one of three SMBG regimens: 1) no testing; 2) once daily testing with standard feedback consisting of glucose values being immediately reported to the patient through the glucose meter; and 3) once daily testing with enhanced patient feedback consisting of glucose values being immediately reported to the patient PLUS automated, tailored feedback messaging delivered to the patient through the glucose meter following each testing. Main outcomes assessed at 52 weeks include quality of life and glycemic control.
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2202-7
​

It doesn't say anything about whether 'eating to your meter' benefits the general population with type 2 diabetes - that would have to be investigated in a separate trial.

 

[Oldvatr]

I may be reading it wrong, but the participants were told to only test once daily.

Well, what use is that? Absolutely none. It is meaningless, and clearly the researchers had no idea how to use meters to the best advantage.

The medical profession in charge of Type 2 diabetic patients have no clue about testing out food, before and after, and using the results to discover what they can or can't eat. When I explained to my lovely nurse how I did this she was amazed. She is a senior nurse, specialises in diabetes, and presents our local X-Pert courses. No-one had ever told her about this way of controlling diabetes. It had never been part of her training - and she keeps up with her training.

From what I read on here, those lucky enough to be prescribed strips are told to test maybe once a day after main meal, but aren't told to test before it, and aren't told what levels they should expect to see. To me this is a complete waste of strips, and gives no-one the opportunity to learn.

I may be reading it wrong, but the participants were told to only test once daily.

Well, what use is that? Absolutely none. It is meaningless, and clearly the researchers had no idea how to use meters to the best advantage.

The medical profession in charge of Type 2 diabetic patients have no clue about testing out food, before and after, and using the results to discover what they can or can't eat. When I explained to my lovely nurse how I did this she was amazed. She is a senior nurse, specialises in diabetes, and presents our local X-Pert courses. No-one had ever told her about this way of controlling diabetes. It had never been part of her training - and she keeps up with her training.

From what I read on here, those lucky enough to be prescribed strips are told to test maybe once a day after main meal, but aren't told to test before it, and aren't told what levels they should expect to see. To me this is a complete waste of strips, and gives no-one the opportunity to learn.

I am a T2D on orals, but things got so bad for me that my GP referred me to the consultant for insulin training. But I did persuade him to support me SMBG for 1 month to see if I could pull things around. I dropped my HbA1c from 99 down to 55 in that month, and I was able to reduce my meds a little, and produce multicoloured graphs of progress, and so he has supported me testing since, nearly 2 years this Sept. I have recently halved my oral meds, and although my levels have risen slightly, I have managed to keep them sensible.

He is impressed with the changes I have managed to make in my care, and supports me fully. But he tells me I am unique in his experience as most of his patients have the 'progressive' variant of the disease. He does not have time to do the research like I can, and he has no backing to allow him to support intelligent education for all, so we are stuck at the moment. I am happy, but he has no remit to step outside the box.

 

[Mr_Pot]

I was suprised by the second part of this statement in the report:
"Today in the U.S., most of the 25 million people with type 2 diabetes do not take insulin. They control their blood sugar with exercise, diet, and sometimes medications such as metformin." I have the impression that the majority of type 2's in the UK are on medication of some sort.

 

[Oldvatr]

b

This trial was basically investigating whether giving patients feedback would improve any benefits of once-daily testing:-

Using stakeholder engagement approach, we developed and implemented a pragmatic trial of patient with non-insulin treated T2DM patients from five primary care practices randomized to one of three SMBG regimens: 1) no testing; 2) once daily testing with standard feedback consisting of glucose values being immediately reported to the patient through the glucose meter; and 3) once daily testing with enhanced patient feedback consisting of glucose values being immediately reported to the patient PLUS automated, tailored feedback messaging delivered to the patient through the glucose meter following each testing. Main outcomes assessed at 52 weeks include quality of life and glycemic control.
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2202-7
​

It doesn't say anything about whether 'eating to your meter' benefits the general population with type 2 diabetes - that would have to be investigated in a separate trial.

There seems to be consensus now that a FBG reading is next to useless, and is a hangover from the days before the HbA1c became available as a general indicator. So 1 test a day tells us nothing, especially since it is so easily skewed by DP and protein intake the night before.

Meters are only really useful under an Eat to Meter regime with supporting education to actually allow changes to be made in almost real time. Otherwise, I agree it is pointless. I was on a 2 tests per week regime for a while, and found it of very limited benefit. I did prove to myself that alcohol consumption the night before dropped my FBG but not much else. Now I can check my supplements, my meds, my greediness, my all with a meter. I dread the day when a smart meter can test sanity too.

 

[Oldvatr]

I was suprised by the second part of this statement in the report:
"Today in the U.S., most of the 25 million people with type 2 diabetes do not take insulin. They control their blood sugar with exercise, diet, and sometimes medications such as metformin." I have the impression that the majority of type 2's in the UK are on medication of some sort.

The ADA has its own take on Eatwell plate, so is that why? Who needs meds when you can carb out a new future. Also, the FDA seems to ban many of the meds that we get prescribed here in UK, so maybe they have less choice. Also, in US, YOU GOTTA PAY for most meds (or Copay) so another incentive to be diet/exercise only.

Edit: Mein Gott, I posted this 5 minutes ago, and it refuses to depart. Trying again in desperation, so bear with me. One day my prints will come! Edit after the fact: That was quick proving that my previous attempts failed indeed since this is the only copy showing.

 

[ringi]

I was suprised by the second part of this statement in the report:
"Today in the U.S., most of the 25 million people with type 2 diabetes do not take insulin. They control their blood sugar with exercise, diet, and sometimes medications such as metformin." I have the impression that the majority of type 2's in the UK are on medication of some sort.

In the UK most people with type 2 diabetes are just on metformin or taking no medication. Metformin has been used in the UK for a lot longer then the USA, as there was no big drug company to pay for the approval of metformin in the USA.

The majority of type 2's in the UK with diabetes controlled by exercise and diet never post anything to the internet!

(Remember there is no good agreement on what levels someone should get labeled Type2 at, or on when people should be tested.)

 

[Bluetit1802]

Before stats showing how many controlled T2s there are become of any use, the word control needs defining.

Many, even on here, are told by their HCP that their HbA1c shows they have good control. That HbA1c may be as high as 53. NICE are now recommending 48 as utopia. (It was 53 previously)

 

[Squire Fulwood]

That's depressing. A bunch of people who don't know what they are doing and one of whom is clearly obese telling millions of people not to bother.

 

[Guzzler]

It is my opinion, and I am still learning and have far to go in my understanding of Diabetes, that education comes first. People respond better once they truly understand the mechanics of the condition. And I know that we can't all be biochemists/bioengineers but we are undoubtedly inteligent enough to understand that suar raises bg and that carbs are changed into sugars which raises bg. Armed with the basics most people can understand and adjust accordingly 'if' they want to. This is why I am becoming more and more angry that I was told only to lower my sugar intake and then sent away with a script. What was the use in that?
Even if HCPs do not agree with the NHS dogma but are 'too busy' to educate people they can steer patients into researching for themselves. In my case I suppose I was lucky in that I have been a member of a support group for a different condition for many years and appreciate that groups of people educate and support each other far better than being given a leaflet and sent away non the wiser.
If you are unaware of the value of testing or have been told that random testing is of benefit to you then of course the results are meaningless. All diabetics should be educated so that we can make informed decisions we (and this encompasses everyone who has lifelong conditions of every description) should not be treated in bovine terms, expected to have blind faith in HCPs and treated with disdain if we dare to break away from the herd.
God, but I'm angry.

 

[Freema]

there are really not that fine results among the average type 2 diabetics........

it is the early death in type 1 that has really been lowered a lot... not the hell-like adding conditions and earlier death in type 2 diabetics , not as I am been informed from the news... I don´t think society should brag about how well type 2 diabetics in average are really doing... I think type 2 diabetics life quallity could better really a lot just by continuingly supporting the individuals much more and by teaching us/them the more effective eating and lifestyles.

 

[bulkbiker]

When I explained to my lovely nurse how I did this she was amazed. She is a senior nurse, specialises in diabetes, and presents our local X-Pert courses. No-one had ever told her about this way of controlling diabetes. It had never been part of her training - and she keeps up with her training.

Bloody hell thats appalling..!