Type 2 NICE and testing strips

[desidiabulum]

Dear All,
I just checked the new NICE guidelines (NG28) on blood tests for T2 and fell out of my chair. I'm pretty certain these represent a significant change of view (in the wrong direction, of course) but I can't put my hands on the previous NICE guidelines to check. Does anyone have them to hand?
It's not just telling GPs not to prescribe test strips-- it's the direction that in the cases where T2s dare to self-monitor (even at their own expense) GPs should carry out an annual assessment of the person's self-monitoring skills, the quality and frequency of testing, the impact on the person's 'quality of life' and 'the continued benefit to the person'. It would be interesting to know what they are looking for re ''quality of life' and 'the continued benefit' -- presumably if people get worried or have sore fingers it's a good time to stop monitoring. Reminds me of a clinical paper published last year saying that the main task was to stop diabetics testing if they were not at risk of hypos, and that the problem was of diabetics being 'psychologically dependent' on testing. So much for Sir David Nicholson's speech (previous Chief Executive of NHS) saying that self-monitoring for T2s was a wonderful example of how the NHS would be saved by people taking responsibility for managing their condition...

 

[asparagusp]

Shocked rather than surprised .....

 

[1abRat]

" the main task was to stop diabetics testing if they were not at risk of hypos, and that the problem was of diabetics being 'psychologically dependent' on testing"

***?!

Sorry, am otherwise lost for words!

 

[dbr10]

" the main task was to stop diabetics testing if they were not at risk of hypos, and that the problem was of diabetics being 'psychologically dependent' on testing"

***?!

Sorry, am otherwise lost for words!

More than a step backwards. Rediculus.

 

[1abRat]

Why do they constantly make the assumption that I'd rather bury my head in the sand?

They seem to think we are delicate little snowflakes (psychologically speaking) who can't cope with the mental burden of diabetes grrrr!

 

[tim2000s]

That guidance was published in November last year. Part of the issue is that NICE doesn't consider SMBG in the context that this forum recommends it, in that you test to determine how food affects you to best select how to eat and eat to your meter, but in the context of medication and "Classical" diabetes dogma.

If you read through the evidence as to why they have made this decision, what it comes down to is low quality evidence combined with lack of cost effectiveness. The trials listed don't seem to apply a consistent method to use of SMBG and that may be where @Administrator could help with organising such research.

The panel's view was:

When making recommendations for the use of self-monitoring, the GDG considered the following points:  Overall, the evidence showed a small reduction in HbA1c levels that was not clinically important.  There was uncertainty around whether self-monitoring was cost effective, but the GDG considered that it was unlikely to be at the magnitude of HbA1c changes reported.  Some medications have been shown to increase the risk of hypoglycaemia. Overall, a strong ‘do not do’ recommendation was made for the majority of people with type 2 diabetes, because the GDG agreed that self-monitoring would not be of sufficient benefit for most people.

The full guidance note is here: https://www.nice.org.uk/guidance/ng28/evidence/full-guideline-78671532569

 

[walnut_face]

I am dependent on testing. Once upon a time my body automatically adjusted BG. I knew nothing about it, then it stopped adjusting, again, I knew nothing about it. I presented symptoms at the surgery, was told I was T2D, bought a meter and now know all about my BG's
Perhaps the risk is I will live too long and drain the state of a pension?

 

[asparagusp]

Running parallel - "NHS set to miss target on foreign patient costs" - http://www.bbc.co.uk/news/health-37790852

 

[Daphne917]

To be honest if I want to test I will - it's my money and if I choose to spend it on looking after my health I will. I no longer tell my DN that I'm testing due to the negativity I get so she probably thinks that the reason my control is so good is because I take her advice to eat low fat, carby foods!

 

[Shar67]

Easy stop telling GP and just go to annual reviews. When they say your blood sugar levels are better, just give them a big obvious wink. When the say meds must be reason, laugh uncontrollably.

Bug bear No1. The past couple of TV programmes show type 2s testing, no mention that this is probably self funded and isn't offered consistently if at all to 2s

Bug bear No2. Even though there is plenty of evidence that testing can be positive in helping 2s take control, the government appears to poo poo idea without proper evaluation.

 

[serenity648]

I have been thinking about this and i sort of agree with the NICE guidelines:

most people with type 2 will follow the eatwell plate stuff. So if they then start self testing, they will get, frustrated, despondent and depressed. And quite possibly anxious.

I am currently on a craft forum where the T2 diabetics are all convinced that there is no point in self testing as (they have been assured by their HCPs) there is nothing they can do about a high reading anyway. And no, despite my best efforts, they will not listen to me, any of them. So self testing, for them, is also pointless.

People believe that their diabetes is progressive and there is nothing they can do to slow down or halt the progress. It is inevitable that they will be on insulin, lose toes etc. So why add the worry of pointless testing to the mix? what will it achieve? And they believe this because everyone in a medical uniform tells them it is so.

So in the face of all the negativity and wrong information they are being bombarded with, why would self testing do any good?

We all know, on here, that this is wrong and harmful. But we are a drop in the ocean, crying in the wilderness, without the authority of medical qualifications. And those of us who would test and use that info wisely are dismissed as wrong and not listened to. We dont figure in the decision making at all.

Do I sound bitter? cos I am bitter, and frustrated, and fearful for members of my family who wont listen, and my friends who wont listen. Apparently I am a blip and maybe I dont have diabetes bslevels anymore because I didnt really have it anyway and the initial tests were a mistake, unlike them. Because everyone knows you cant do anything about your blood sugar levels without more and more meds.

(falls off soapbox and grabs chicken breast)

sorry, this turned into a bit of a rant.

 

[donnellysdogs]

@tim2000s thanks for all tgat info...

Isn't it about time that NICE woke up to the fact thst poor control and risks are not all centred around hypo's?

Can't diabetes.co.ul etc push for NICE to recognise high levels as being tge biggest cause..

At least with hypo's tge vast majority sre recognised by patients.... high levels aren't l...

 

[Covlocks]

I just had my 6 monthly medication review and I said to the DSN what are you reviewing as I haven't had my blood test done since last year. She said that they only test once a year now and my last test was OK so no problem. I said how do you know if my blood sugars are better or worse as we don't get a test kit and you don't like us self testing . We will call you in s few months for a blood test she said. What the heck is going on? Cost saving I understand, but if I wanted a sex change there would be no problem, but something more important in my eyes can take a back seat.

 

[Chook]

The problem is there are so few of us that use meters to find out how our bodies respond to different foods that we haven't got a big enough voice to change or influence policy like this.

I'm one of the 'lucky ' ones my DN gave me a meter and I get 200 strips on prescription each month. 'All' I had to do was let my T2 get so out of control that I was put on to insulin injections. Every time I have a review now I'm worried that they will withdraw the strips because I am no longer on the insulin - I've tried explaining that I still describe myself as insulin dependent but that I haven't needed to use any for the last twenty months because I keep to a very low carb diet. But the DN made a comment about my use of the strips at my recent review which makes me think they might be stopped unless, of course, I start using insulin again.