I've just been having a trawl through the NICE guideline document (CG66 Type 2 Diabetes: full guideline) which can be found at:
http://www.nice.org.uk/nicemedia/live/1 ... /40803/pdf If this doesn't work as a link, it will be because I followed a link on the NICE website to get to it, but if you go to nice.org.uk and search for CG66 Type 2 Diabetes, or similar, you should find it.
These are some extracts from it (the numbers in brackets eg (50) are for the footnotes in the original) :
6 Lifestyle management/non-pharmacological management
6.1 Dietary advice
6.1.1 Clinical introduction
All people with Type 2 diabetes should be supported to:
_ try to achieve and maintain blood glucose levels and blood pressure in the normal range
or as close to normal as is safely possible
_ maintain a lipid and lipoprotein profile that reduces the risk of vascular disease.
***
it can be argued that limited credence can be given to observational study associations between blood glucose control and self-monitoring as those patients and healthcare professionals who
advocate self-monitoring may be the same people who are motivated to achieve better control.
***
8.1.3 Health economic methodological introduction
A cost analysis of implementing intensive control of blood glucose concentration in England
identified increased frequency of home glucose tests as a main contributor to the total costs of
intensive control.(52) It was estimated that the additional management costs of implementing
intensive control policies would be £132 million per year, of which £42.2 million would be on
home glucose tests. The sensitivity analysis results found that changes in the unit cost of home
blood glucose strips (baseline cost £0.27, range tested £0.16–£0.40) in the proportion of
patients already being managed intensively, and the costs of intensifying management, had the
largest impact on the cost of implementation.
***
The study by Jansen also reported that interventions with SMBG were found to be more
effective in reducing HbA1c than interventions without self-monitoring. The reduction in
HbA1c was statistically significant and it was estimated to be around 0.4%. This effect was
increased when regular feedback was added to the SMBG and was shown in both an insulin treated Type 2 diabetes group, and in a group of Type 2 diabetes patients that included those
being treated with oral agents.
***
Pros of self-monitoring:
_ provides a heightened awareness of, and evidence of, the condition
_ when readings are within advised guidelines and fluctuations are easily interpretable,
patients emphasise the positive role that monitoring has in their diabetes management. Low
readings are a high point giving personal gratification
_ cultivates independence from health services and enhances self-regulation.
Cons of self-monitoring:
_ potentially, self-monitoring can raise anxiety about readings
_ blood glucose parameters were found to be problematic by patients when they felt they
were receiving contradictory information about upper thresholds or no guidance about
ideal parameters
_ lack of awareness as to how to manage hyperglycaemia
_ increased self-responsibility accompanied by increased self-blame and negative emotional
reactions to high glucose readings
_ counter-intuitive readings could be sources of distress and anxiety, in some cases
adversely effecting adherence to diabetic regimens by promoting nihilistic attitudes
_ healthcare professionals were not interested in readings.(50)
***
RECOMMENDATIONS
R22 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.
R23 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.
R24 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.
R25 If self-monitoring is appropriate but blood glucose monitoring is unacceptable to the
individual, discuss the use of urine glucose monitoring.
Obviously I haven't copied all the document, so these are self-selected and may be biased! But I would say, reading the recommendations, that they at least could be argued either way, particularly under R23.
I would also suggest that self-monitoring would help our doctors monitor our condition, as they are now being told to rely on HbA1c results. Lower HbA1c means fewer complications eg CVD, amputations etc, and therefore means lower costs in the future. If self-monitoring keeps us interested, self-motivated and pro-active in managing our condition, and keeps our feet on and ours eyes working properly, it has really got to be beneficial all round!
The things I do on a Sunday afternoon :shock:
Go in and argue with them, Spitfire! I don't think they are managing you 'intensively', by the sound of things! and how much 'education' have they given you? The guidelines advocate an intensive education programme, eg DESMOND and more, in an earlier section.
Viv