Hi....anyone see news to-day....going on about self testing.....is a waste of time they say ....oh boy looks as we may struggle getting stuff of gps ..says the money should be spent on excercise ect.. :cry: saffy
news this lunchtime over testing
- Thread starter saffy1
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Absolutely ridiculous!
We really ought to all write to Diabetes UK and to the BBC (and whichever other channels run this nonsense story) to explain that the "reasearch" which has been done is based on some very shaky information.
How on earth anyone is meant to manage their diabetes without testing is beyond me. This is dangerous.
In any event, the NICE guidelines still say that everyone has the right to test, so for the time being, let's hope that doesn't change!
We really ought to all write to Diabetes UK and to the BBC (and whichever other channels run this nonsense story) to explain that the "reasearch" which has been done is based on some very shaky information.
How on earth anyone is meant to manage their diabetes without testing is beyond me. This is dangerous.
In any event, the NICE guidelines still say that everyone has the right to test, so for the time being, let's hope that doesn't change!
I have been told i can have strips to test twice a week, well as i posted under "Blood glucose testing strips" I drive a 7.5 tonne van and if i did not test as and when i need to i would have been on a motorway for two hours and started at 3.9mmol, but was 7.1 not 45 mins earlier.
Just how many could i kill if i black out just to SAVE some money.
Just how many could i kill if i black out just to SAVE some money.
Hey, i'm type 1 so don't have that problem but i saw the news and was absolutely horrified, it's bang out of order to restrict type 2's testing, how on earth are you supposed to look after yourselves, it'll just leed to lot's of people being less controlled and will then start a snowball effect when there are more people with complications.
I find this absolutely ridiculous - diabetes is a self managed illness whether it's type 1 or 2, or gestational.
I have type 1 and, especially throughout my pregnancies, test 8-12 times some days. I get 200 test strips every few weeks and cannot imagine having to 'ration' myself (although I know they would never do that to type 1s)
Surely the 'powers that be' will realise that this can't happen?
I have type 1 and, especially throughout my pregnancies, test 8-12 times some days. I get 200 test strips every few weeks and cannot imagine having to 'ration' myself (although I know they would never do that to type 1s)
Surely the 'powers that be' will realise that this can't happen?
They seem to see type 2 as a 'life-style' disease therefore it's our own fault and we are probably too stupid to be able to monitor it effectively!! :x :x :x
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I wonder if we could organise a petition using this site? What would we be actually petitioning against, the study or potential changes in legislation? If someone wants to draft one, I can check with the tech team and see if we can host such a thing? If we gathered names we could potentially present to BBC/DUK.
Regards,
Admin
Regards,
Admin
Sounds like a good idea,I think the main thrust would be against any potential legislation but also mention using out dated material.
bluebird
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I think we should petition the gov. You can put a petition on http://www.petitions.pm.gov.uk and I expect individuals sign up to it (not sure how it works). We need to use the best method to give as high a profile as poss. Any thoughts?
Regards Val
Regards Val
Hi all, say when will definitly add our name to the list, I would guess the ones that are shouting re: testing are not diabetic and don't know what they are talking about junieliz
It is ridiculous to expect type 2 diabetics to manage their diabetes based on 2 BS readings a week, what do you do if your ill. I'm type 1 if i get a cold I increase my testing to around 8 times a day and if I get really bad time I inject 6 - 8 times a day just to keep myself at a good level. Its disgusting that they are teating type 2 diabetics that way just because of this stupid lifestyle idea - i know plenty of type 2 diabetics that ate healthy diets, never drank, smoked and exercised and they got it. When will the politicians realise not everything in the world can be blamed on what WE put in our bodies!
Kim
Kim
IanD
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My wife & I were screened for heart & diabetes as part of a research study into the incidence of health problems with Asians - we live in Southall.
My Dr considered there was no risk, even with a cholesterol of 6.4. There were no other health factors. I have an active lifestyle & diet.
That was about 4 years before I was diagnosed with diabetes.
My Dr considered there was no risk, even with a cholesterol of 6.4. There were no other health factors. I have an active lifestyle & diet.
That was about 4 years before I was diagnosed with diabetes.
I didn't see the news at lunch time as I was at work, however I've just got home to find a letter (dated 17th April) from my GP about this very subject.
The letter tells me that from March 08, I will only allowed 100 strips a year (enough for twice a week testing, they tell me this is practice policy).
I'm furious, I had an appointment only last Wednesday (16th) with the diabetic nurse, she told me nothing of this. Furthermore, she complimented me on my blood glucose control and the records I keep.
I'm just about to write to the practice manager and voice my objections. :x
The letter tells me that from March 08, I will only allowed 100 strips a year (enough for twice a week testing, they tell me this is practice policy).
I'm furious, I had an appointment only last Wednesday (16th) with the diabetic nurse, she told me nothing of this. Furthermore, she complimented me on my blood glucose control and the records I keep.
I'm just about to write to the practice manager and voice my objections. :x
IanD
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Testing twice a week will tell you & the Dr nothing about your control.
Type 1s have to test & eat or inject, but what action should type 2s take? There is no need to regulate our eating & medication.
I test every morning, fasting, & later in the day, my meter says 54 times in 30 days.
My overnight readings are normally 6-6.5 & then I have breakfast. If they were higher or lower I would still have breakfast. My readings 2 hours after a meal are normally 7-10 (ave 7.7, but occasionally above 10. These readings show my control is good. I therefore do not need to act on the individual readings.
When I had a leg muscle problem, I saw 2 Drs in a week, & they were intending to consult each other. I went back over two months of readings. Before the pain came on, my fasting average was 6.7. During the period of pain, my average went above 7. When the pain eased, the average was down to 6.7 again. Two readings a week would not have given me that information.
The Drs will tend to rely on their HbA1c tests, but they are a year apart. Its our life & health they are affecting, & the resultant problems will be much more costly to patient & NHS & to the motor insurance if we are not allowed to know how well badly we are controlling our condition.
Type 1s have to test & eat or inject, but what action should type 2s take? There is no need to regulate our eating & medication.
I test every morning, fasting, & later in the day, my meter says 54 times in 30 days.
My overnight readings are normally 6-6.5 & then I have breakfast. If they were higher or lower I would still have breakfast. My readings 2 hours after a meal are normally 7-10 (ave 7.7, but occasionally above 10. These readings show my control is good. I therefore do not need to act on the individual readings.
When I had a leg muscle problem, I saw 2 Drs in a week, & they were intending to consult each other. I went back over two months of readings. Before the pain came on, my fasting average was 6.7. During the period of pain, my average went above 7. When the pain eased, the average was down to 6.7 again. Two readings a week would not have given me that information.
The Drs will tend to rely on their HbA1c tests, but they are a year apart. Its our life & health they are affecting, & the resultant problems will be much more costly to patient & NHS & to the motor insurance if we are not allowed to know how well badly we are controlling our condition.
I think it would be best for doctors/nurses to asses each patient individually and see what number of test strips are appropriate.
I don't think 2 tests a week is enough.
maybe something like 5 tests per day for the first 6 months and then 2 tests a day thereafter as some kind of rough guideline.
Even if the individual practice has a policy then surely the GP can override that if they think the patient needs them.
I don't think 2 tests a week is enough.
maybe something like 5 tests per day for the first 6 months and then 2 tests a day thereafter as some kind of rough guideline.
Even if the individual practice has a policy then surely the GP can override that if they think the patient needs them.
Hi all, My husband who is type 2 recieved a letter about a year ago stating that the test strips were to be withdrawn for type 2, and then invited to a discussion at the surgery with the nurse and someone else who was expert in this field re: test strips being withdrawn, Only four people turned up to the meeting so wasn't a grand turn out, and it was said because of my husbands medication Novanorm and he does go hypo he could keep on with his strips, but it was said that on Metformin you cannot go hypo so these people don't need the strips. He tests daily and so far he has been able to recieve his strips. Only yesterday when he came home from work he tested and was 2.6 very low and he was able to remedy this so the strips we feel are needed for him and others. Also when he was diagnosed he went to the doctors with his back and mentioned his losing weight and was sent for a blood test and his reading was 30 but apart from losing weight he didn't feel ill so the testing is a major tool. Take care junieliz
Surely this "testing a waste of time" news is just to save the NAtional Health some money?
ok so you go to the nurse or the diabetic centre and give your little bottle containing early morning r pee as requested, then the nurse does blood test on you finger as usual and it goes into the big machine that clanks and wheezes a while and the give you the average reading for the PAST three months!
And this is supposed to help you maintain your sugar leels? Fooey.. its GONE PAST! How stoopid is that?
if you test first thing then you know! and you can do something about it!
its the most irresponsible thing I have ever heard!
Silkstone... grrr
ok so you go to the nurse or the diabetic centre and give your little bottle containing early morning r pee as requested, then the nurse does blood test on you finger as usual and it goes into the big machine that clanks and wheezes a while and the give you the average reading for the PAST three months!
And this is supposed to help you maintain your sugar leels? Fooey.. its GONE PAST! How stoopid is that?
if you test first thing then you know! and you can do something about it!
its the most irresponsible thing I have ever heard!
Silkstone... grrr
Alan S
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I'll repeat here the response I wrote on misc.health.diabetes. Sorry if some have read it before.
The crux of the problem in this study lies in the following section. First, I'll give the unabridged version, then highlight some points. You can save time by scrolling down to "This is the absolutely critical part".
From the study:
***
"After an initial assessment visit, eligible patients were randomised into intervention (self monitoring of blood glucose) or control (no monitoring) groups with a randomly generated allocation code in consecutively numbered sealed envelopes. The study diabetes nurse at each hospital site performed the treatment allocation.
Patients in the self monitoring group were all provided with a single glucose monitor (Lifescan OneTouch Ultra; Johnson and Johnson, Milpitas, CA) and instructed in its use. They were asked to monitor four fasting and four postprandial capillary blood glucose measurements each week. They were advised on appropriate responses to high or low readings. Such advice included the need for dietary review or the suggestion of exercise (such as walking) in response to high readings.
At each clinic visit, concordance with the self monitoring regimen was verified by downloading meter readings.
Patients in the no monitoring group (control) were asked not to acquire a meter or perform monitoring for the duration of the study.
Patients in both groups underwent an identical structured education programme involving diabetes nurse practitioners, dieticians, podiatrists, and medical staff. All patients were reviewed by the doctor, diabetes nurse practitioner, and dietician at three monthly intervals for one year. At
each visit all aspects of diabetes care were reviewed including indices of glycaemic control (HbA1c for both groups and self monitoring results for the self monitoring group). Patients in the self monitoring group received ongoing advice and support in the appropriate interpretation of and response to their capillary glucose results.
We used an identical treatment algorithm for dietary and pharmacological management of glycaemia for both groups based on HbA1c targets (figure 1)Go. Blood concentrations of HbA1c, lipids, and electrolytes were measured at or before each clinic and results were discussed with patients in the context of the treatment targets. Measurement of HbA1c was performed in the local hospital laboratory with a diabetes control and complications trial (DCCT) aligned HbA1c assay.2 All laboratories participated in HbA1c external quality assurance, which was satisfactory for the duration of the study. All other laboratory tests were also performed in the local hospital laboratory, where staff were blinded to treatment allocation."
***
This is the absolutely critical part:
"They were asked to monitor four fasting and four postprandial capillary blood glucose measurements each week.
They were advised on appropriate responses to high or low readings. Such advice included the need for dietary review or the suggestion of exercise (such as walking) in response
to high readings."
What were the "appropriate" responses they used? What was that advice?
Some idea of what may have been advised appears here:
"Patients in both groups underwent an identical structured education programme involving diabetes nurse practitioners, dieticians, podiatrists, and medical staff."
And what do we know of the education dietary programme provided by the NHS or Diabetes UK? Basically it is low-fat, high carb and add more metformin or insulin to counter the carbs. On the use of meds, take a look at Table 5 noting the increase in medications across the board and the higher use of multiple medications in the SMBG group.
So, when these meter users tested at their random four post-prandials (or, at least, the 63 of 96 who actually tested 80% of the required four FBG and four PP weekly; meaning that 50% actually tested that much, almost certainly at two hours and well after their post-prandial spike), what
did they do about it if it was high? Did they reduce carbs? Possible but most unlikely if they complied with their advice. More likely they went for a walk or the doctor upped their metformin or added a med (see Figure 1 and Figure 5).
And they probably missed most of their spikes anyway, often seeing only the reactive post-spike numbers at two hours.
So they did what they were told and their numbers didn't improve. No wonder they got depressed. I would have too.
What was that old definition for insanity? "To continue to do the same thing and expect a different result."
In my opinion the control group weren't as depressed because they put themselves in the hands of their doctors - no personal responsibility for their plight. But the SMBG group felt they must share the blame for their poor response; especially those who were in the 50% who didn't do all the
weekly tests.
The problem was not the SMBG but the ignorance of those conducting the research on how to best train the SMBG group on how to use the test results to improve the diet to improve results.
This research is little different to the earlier and similar BMJ report from Farmer et al, which I note is listed as the 13th reference:
http://www.bmj.com/cgi/content/full/bmj ... 47431.BEv1
You will see my response to that in BMJ at the foot of that page, or here:
http://www.bmj.com/cgi/eletters/bmj.392 ... Ev1#170665
It is equally relevant to this load of nonsense. If you go to the ready response index you will find several other patient's and doctor's similar responses.
The only funding acknowledgement was "Funding: Northern Ireland research and development office. MC was employed as a research associate as part of the funding allocation. The
blood glucose meters were supplied free of charge by Johnson and Johnson, Milpitas, CA." I am cynical enough to wonder how much of the funding effectively came from the bean-counters of the NHS.
The crux of the problem in this study lies in the following section. First, I'll give the unabridged version, then highlight some points. You can save time by scrolling down to "This is the absolutely critical part".
From the study:
***
"After an initial assessment visit, eligible patients were randomised into intervention (self monitoring of blood glucose) or control (no monitoring) groups with a randomly generated allocation code in consecutively numbered sealed envelopes. The study diabetes nurse at each hospital site performed the treatment allocation.
Patients in the self monitoring group were all provided with a single glucose monitor (Lifescan OneTouch Ultra; Johnson and Johnson, Milpitas, CA) and instructed in its use. They were asked to monitor four fasting and four postprandial capillary blood glucose measurements each week. They were advised on appropriate responses to high or low readings. Such advice included the need for dietary review or the suggestion of exercise (such as walking) in response to high readings.
At each clinic visit, concordance with the self monitoring regimen was verified by downloading meter readings.
Patients in the no monitoring group (control) were asked not to acquire a meter or perform monitoring for the duration of the study.
Patients in both groups underwent an identical structured education programme involving diabetes nurse practitioners, dieticians, podiatrists, and medical staff. All patients were reviewed by the doctor, diabetes nurse practitioner, and dietician at three monthly intervals for one year. At
each visit all aspects of diabetes care were reviewed including indices of glycaemic control (HbA1c for both groups and self monitoring results for the self monitoring group). Patients in the self monitoring group received ongoing advice and support in the appropriate interpretation of and response to their capillary glucose results.
We used an identical treatment algorithm for dietary and pharmacological management of glycaemia for both groups based on HbA1c targets (figure 1)Go. Blood concentrations of HbA1c, lipids, and electrolytes were measured at or before each clinic and results were discussed with patients in the context of the treatment targets. Measurement of HbA1c was performed in the local hospital laboratory with a diabetes control and complications trial (DCCT) aligned HbA1c assay.2 All laboratories participated in HbA1c external quality assurance, which was satisfactory for the duration of the study. All other laboratory tests were also performed in the local hospital laboratory, where staff were blinded to treatment allocation."
***
This is the absolutely critical part:
"They were asked to monitor four fasting and four postprandial capillary blood glucose measurements each week.
They were advised on appropriate responses to high or low readings. Such advice included the need for dietary review or the suggestion of exercise (such as walking) in response
to high readings."
What were the "appropriate" responses they used? What was that advice?
Some idea of what may have been advised appears here:
"Patients in both groups underwent an identical structured education programme involving diabetes nurse practitioners, dieticians, podiatrists, and medical staff."
And what do we know of the education dietary programme provided by the NHS or Diabetes UK? Basically it is low-fat, high carb and add more metformin or insulin to counter the carbs. On the use of meds, take a look at Table 5 noting the increase in medications across the board and the higher use of multiple medications in the SMBG group.
So, when these meter users tested at their random four post-prandials (or, at least, the 63 of 96 who actually tested 80% of the required four FBG and four PP weekly; meaning that 50% actually tested that much, almost certainly at two hours and well after their post-prandial spike), what
did they do about it if it was high? Did they reduce carbs? Possible but most unlikely if they complied with their advice. More likely they went for a walk or the doctor upped their metformin or added a med (see Figure 1 and Figure 5).
And they probably missed most of their spikes anyway, often seeing only the reactive post-spike numbers at two hours.
So they did what they were told and their numbers didn't improve. No wonder they got depressed. I would have too.
What was that old definition for insanity? "To continue to do the same thing and expect a different result."
In my opinion the control group weren't as depressed because they put themselves in the hands of their doctors - no personal responsibility for their plight. But the SMBG group felt they must share the blame for their poor response; especially those who were in the 50% who didn't do all the
weekly tests.
The problem was not the SMBG but the ignorance of those conducting the research on how to best train the SMBG group on how to use the test results to improve the diet to improve results.
This research is little different to the earlier and similar BMJ report from Farmer et al, which I note is listed as the 13th reference:
http://www.bmj.com/cgi/content/full/bmj ... 47431.BEv1
You will see my response to that in BMJ at the foot of that page, or here:
http://www.bmj.com/cgi/eletters/bmj.392 ... Ev1#170665
It is equally relevant to this load of nonsense. If you go to the ready response index you will find several other patient's and doctor's similar responses.
The only funding acknowledgement was "Funding: Northern Ireland research and development office. MC was employed as a research associate as part of the funding allocation. The
blood glucose meters were supplied free of charge by Johnson and Johnson, Milpitas, CA." I am cynical enough to wonder how much of the funding effectively came from the bean-counters of the NHS.
Thanks Alan- great post and links.
SBGM is a waste of time for some diabetics (knowing what my many type 2 relatives are like). Thererin lies the crux of testing- motivation by knowledge. The current standard dietry advice available in the UK and in these studies is flawed as we all know. As I wrote previously, these trials test the quality of the medical care and not the results of SBGM. It is alo interesting in design terms that these randomised trials did not test the null hypothesis- biased from the very start (especially the Farmer study).
The problem for PCTs/GPs is that pharmacy advisers will be trying to balance the books and will attempt to adopt a blanket ban on all SBGM for non-insulin users. I get the impression that hospital based diabetic teams are immensely enthusiastic for SBGM. GPs will see lots of lapsed type 2s who will not always be that involved with self regulation. That fraction (including many of my relatives) tar the whole group. One can imagine how GPs will be turned off by the over eager over achiever with screeds of test results and downloaded graphs of readings. My retired diabetologist warned me not to do that to him.
I think we are a fairly expensive group of patients already, maybe there is some financial resentment of that.
SBGM is a waste of time for some diabetics (knowing what my many type 2 relatives are like). Thererin lies the crux of testing- motivation by knowledge. The current standard dietry advice available in the UK and in these studies is flawed as we all know. As I wrote previously, these trials test the quality of the medical care and not the results of SBGM. It is alo interesting in design terms that these randomised trials did not test the null hypothesis- biased from the very start (especially the Farmer study).
The problem for PCTs/GPs is that pharmacy advisers will be trying to balance the books and will attempt to adopt a blanket ban on all SBGM for non-insulin users. I get the impression that hospital based diabetic teams are immensely enthusiastic for SBGM. GPs will see lots of lapsed type 2s who will not always be that involved with self regulation. That fraction (including many of my relatives) tar the whole group. One can imagine how GPs will be turned off by the over eager over achiever with screeds of test results and downloaded graphs of readings. My retired diabetologist warned me not to do that to him.
I think we are a fairly expensive group of patients already, maybe there is some financial resentment of that.
