Cutting inappropriate blood glucose self-monitoring ‘could save NHS £20m’

junemc153 · Apr 10, 2015

Report just published on a study in Tower Hamlets with regard to the above. I have attached it.

I think this will be replicated elsewhere in the NHS - one interesting thing is that they haven't monitored whether self-managed BG levels rose or changed or how many more patients ended up on medication as a result of not testing!!!

jack412 · Apr 10, 2015

save 20mil now and spend 100mil late on complications

tim2000s · Apr 10, 2015

This was originally posted on the April 1st in a couple of topics. Sadly, what looked to be an April Fool's appears to be true.

CollieBoy · Apr 10, 2015

tim2000s said:
This was originally posted on the April 1st in a couple of topics. Sadly, what looked to be an April Fool's appears to be true.

Unfortunately the fools (the GPs) will not be the ones paying the price (the patients) To work effectively SMBG needs to be used as a tool to provide data to improve the results, not as an end in itself!
As a parallel blood/urine bacteria testing is totally useless unless the patient is given appropriate antibiotics as a result of a positive test!

Heathenlass · Apr 10, 2015

The issue that struck me in reading that was that test strips should not be issued to Type 2's " who are not at risk of hypoglycaemia "

That completely misses the point. From what I have read on here, hypoglycaemia is not what the majority are testing for anyway, it's the achievement of good BG figures . You simply can't tell what a person's overall control is like by an annual or biannual Hba1c . I also seems from that study that when meters and strips were prescribed, very little education was given in their use, so that was self defeating

Cynical me also thinks their choice of location for the study would skew he projected savings for the NHS, given that these areas have the highest numbers of Type 2's in the country.

Signy

Spencer67 · Apr 10, 2015

I went to my Diabetes Specialist yesterday and he told me I "should only be testing 4 times per day, over zealous testing would just get me sore fingers". The phrase "No S**t Sherlock" nearly left my lips but i managed to restrain myself. There is a lot of money in the test strip market though they are at least £15-£20 for 50, imo great technology but over priced. Must be a considerable burden on the nhs, if they cut the cost by half wouldn't this remedy part of the issue?

Nuthead · Apr 10, 2015

I don't think I will read this. I am saving my limited brain power for something worthwhile.....

Heathenlass · Apr 10, 2015

Nuthead said:
I don't think I will read this. I am saving my limited brain power for something worthwhile.....

You are probably right @Nuthead . It's an exercise in justification that ignores the long term implications .

And probably bad for your blood pressure

Signy

Dillinger · Apr 10, 2015

I've had a bit of a rant about this on a low-carb website. This is what I said there:

This is absolute idiotic. The study is essentially saying; X costs money, we are investigating whether doing less of X costs less money. The conclusion? It does! Wow! Money well spent study people.

This will get waved in the face of Type 2's as proof of something else entirely.

Note how that it does not appear to address at all the core assertion that "(SMBG) confers no benefit for many people with type 2 diabetes". That is outrageous and it's patently untrue. If and here's the million dollar 'if'; if you know what to do about the results and can free yourself from the things causing the high blood sugar.

From reading the link there is no suggestion at all that HbA1c was even measured. So how can they test that?

Additionally, of course, as it is NHS policy to keep to the low-fat high carb diet and I'm betting that the diet these people would have been advised to stick to would be just that; the good old NHS diet of death and guess what? Even with blood testing if you are eating 100's of carbs a day and you are Type 2 things aren't going to get better.

Also note this bit of 'we're not very good at this job so let's fudge the results' type thinking;

"Patients report that use of SMBG can be associated with feelings of blame or failure, and disappointment when clinicians are disinterested in readings."

So, you've been given really bad nutritional advice and you do your best to follow it but your devilish SMBG is just showing that the nutritional advice is rubbish Guess what? These are DOCTORS speaking to you and even more certain in their knowledge DIABETIC NURSES; so poor you - the reason your blood sugars are so appalling is you; you are the failure. "You're not really following the diet we set are you? Do you like chocolate? Of course you do. Hobnob?"

To compound all this when you ask about your blood sugars the doctors say "I can't be bothered to look at your silly little jottings in your school book. I bet that makes your feel like no one gives a ****? Yes, yes. Well done. We'll see you in 12 months if you excuse me I have a meeting with that nice man from Merck; he's got a fantastic golf handicap."

So, the advice is terrible and no-one follows up on the data you have showing that. The best thing to do? Get rid of the data! Everyone's a winner. Except you. But you can't have everything eh? Or in your case 'anything'.

Madness....

Dillinger

Dillinger · Apr 10, 2015

Heathenlass said:
The issue that struck me in reading that was that test strips should not be issued to Type 2's " who are not at risk of hypoglycaemia "
/QUOTE]

That's because as we all know well the only risk to diabetics is low blood sugars; high blood sugars are absolutely fine and don't lead to any complications. Isn't that right? Something like that? Apart from well, er, all the complications we suffer. But that aside that's pretty much the situation...

iHs · Apr 10, 2015

My thoughts on this is that as far as I am aware, type 2 diabetics who are controlled by oral med and diet are not prescribed teststrips. So, if type 2s are using insulin, why is this? What has gone wrong with controllong sugar levels for these people using the med that they have been prescribed? What has the surgery nurses told type 2s to eat diet wise? Its nowhere near good enough to just say cut back on sugar, when the real culprit is carbohydrate which breaks down to glucose and as such, increases weightgain. If better diet education was given in the first place, many type 2s would lose weight, lose insulin resistance and might be able to stop med. That would leave the prescribing of teststrips left to type 1s. Also, the companies responsible for the manufacture of teststrips are getting away with ripping the NHS off with the prices they charge and the government health ministers need to tackle this and not be fobbed off by being told that the revenue that is made gets ploughed back in to create better technology. Some of it does, but the rest goes into giving the managers a lovely lifestyle no doubt. No one should really object to using a bg meter that takes cheaper teststrips unless there is a need to carry on with the existing as that would then make most of the companies lose revenue and reduce prices.

Nuthead · Apr 10, 2015

iHs said:
My thoughts on this is that as far as I am aware, type 2 diabetics who are controlled by oral med and diet are not prescribed teststrips. So, if type 2s are using insulin, why is this? What has gone wrong with controllong sugar levels for these people using the med that they have been prescribed? What has the surgery nurses told type 2s to eat diet wise? Its nowhere near good enough to just say cut back on sugar, when the real culprit is carbohydrate which breaks down to glucose and as such, increases weightgain. If better diet education was given in the first place, many type 2s would lose weight, lose insulin resistance and might be able to stop med. That would leave the prescribing of teststrips left to type 1s. Also, the companies responsible for the manufacture of teststrips are getting away with ripping the NHS off with the prices they charge and the government health ministers need to tackle this and not be fobbed off by being told that the revenue that is made gets ploughed back in to create better technology. Some of it does, but the rest goes into giving the managers a lovely lifestyle no doubt. No one should really object to using a bg meter that takes cheaper teststrips unless there is a need to carry on with the existing as that would then make most of the companies lose revenue and reduce prices.

Cancer treatment and steroids given in vast quantities in A and E to keep me alive forced me into insulin. The consultant said he was not surprised my pancreas gave up and this is quite common.

Heathenlass · Apr 10, 2015

Dillinger said:
I've had a bit of a rant about this on a low-carb website. This is what I said there:

This is absolute idiotic. The study is essentially saying; X costs money, we are investigating whether doing less of X costs less money. The conclusion? It does! Wow! Money well spent study people.

***!

This will get waved in the face of Type 2's as proof of something else entirely.

Note how that it does not appear to address at all the core assertion that "(SMBG) confers no benefit for many people with type 2 diabetes". That is outrageous and it's patently untrue. If and here's the million dollar 'if'; if you know what to do about the results and can free yourself from the things causing the high blood sugar.

From reading the link there is no suggestion at all that HbA1c was even measured. So how can they test that?

Additionally, of course, as it is NHS policy to keep to the low-fat high carb diet and I'm betting that the diet these people would have been advised to stick to would be just that; the good old NHS diet of death and guess what? Even with blood testing if you are eating 100's of carbs a day and you are Type 2 things aren't going to get better.

Also note this bit of 'we're not very good at this job so let's fudge the results' type thinking;

"Patients report that use of SMBG can be associated with feelings of blame or failure, and disappointment when clinicians are disinterested in readings."

So, you've been given really bad nutritional advice and you do your best to follow it but your devilish SMBG is just showing that the nutritional advice is rubbish Guess what? These are DOCTORS speaking to you and even more certain in their knowledge DIABETIC NURSES; so poor you - the reason your blood sugars are so appalling is you; you are the failure. "You're not really following the diet we set are you? Do you like chocolate? Of course you do. Hobnob?"

To compound all this when you ask about your blood sugars the doctors say "I can't be bothered to look at your silly little jottings in your school book. I bet that makes your feel like no one gives a ****? Yes, yes. Well done. We'll see you in 12 months if you excuse me I have a meeting with that nice man from Merck; he's got a fantastic golf handicap."

So, the advice is terrible and no-one follows up on the data you have showing that. The best thing to do? Get rid of the data! Everyone's a winner. Except you. But you can't have everything eh? Or in your case 'anything'.

Madness....

Dillinger

Well said, @Dillinger ! * applauds * Excellent post !

Signy

sanguine · Apr 10, 2015

A comment from my DN recently put some context on this. On here we are all motivated so quite rightly we see this as a bonkers idea. She said though that many patients who had been prescribed meters and strips did the tests, but only wrote the numbers down and brought them in next time, they did nothing with the information.

I tried to argue then that well obviously they should have been given some instruction and education as to what the numbers mean and how they can use the data to manage their condition better. And by the way if you also tell them to eat a low carb diet they will see improvements which then becomes incentivising (aarrgghh I'm using management-speak now, help!). I think she agreed (off the record my DN thinks the Eatwell Plate is a disaster for diabetics but has to spout out the NICE guidance) but her hands are tied. I reckon they don't want to issue meters to T2s because with most people it will - tragically for them - show that the dietary advice worsens their condition, and we wouldn't want that coming out would we?

desidiabulum · Apr 10, 2015

The British Journal of General Practice publishes letters vociferously disagreeing with research papers that it has published. The fallacies, non sequiturs and sheer cynicism of this article need attacking in BJGP as soon as possible, and it should not be difficult to point them out. It would be nice if one or two of the GPs who post here could write in to the BJGP -- letters from medical staff will carry more weight.
Given where it has been published, it is difficult to think of a more potentially damaging article for T2 care.
If we cannot persuade GPs to respond we need to do something ourselves. Please PM me if you have any ideas or would like to help draft something.

Spencer67 · Apr 10, 2015

Perhaps someone with a bit of diabetes street cred could petition the parmos to cut the cost of the test strips i know i'd sign it. I foresee a huge problem that the pharmos are exploiting by milking the nhs for all its cash via the back door of the current diabetes epidemic, most medicines we take for granted as diabetics are largely quite expensive and if the nhs was to crumble and the support was gone what would we do? The NHS has only been about since 1948, Cameron could have it blown out of the water by this next election.

"We rely on the NHS at the best and worst moments of our life" I signed this petition today its just the start of the specter of privatisation,
https://secure.38degrees.org.uk/page/s/party-leaders-keep-the-nhs-free#petition If you haven't already signed it you may need too consider it before the next election.

Paul59 · Apr 10, 2015

Strange this thread has come about.
I only yesterday emailed my MP who is a dr & deals with medical issue in Parliament.
Waiting on a reply.

Heathenlass · Apr 10, 2015

Spencer67 said:
Perhaps someone with a bit of diabetes street cred could petition the parmos to cut the cost of the test strips i know i'd sign it. I foresee a huge problem that the pharmos are exploiting by milking the nhs for all its cash via the back door of the current diabetes epidemic, most medicines we take for granted as diabetics are largely quite expensive and if the nhs was to crumble and the support was gone what would we do? The NHS has only been about since 1448, Cameron could have it blown out of the water by this next election.

"We rely on the NHS at the best and worst moments of our life" I signed this petition today its just the start of the specter of privatisation,
https://secure.38degrees.org.uk/page/s/party-leaders-keep-the-nhs-free#petition If you haven't already signed it you may need too consider it before the next election.

1448, @Spencer67 ?

The year of free leeches for all ?

Signy

Spencer67 · Apr 10, 2015

Heathenlass said:
1448, @Spencer67 ? The year of free leeches for all ?

Signy

ooops update time

copepod · Apr 10, 2015

Paul59 said:
Strange this thread has come about.
I only yesterday emailed my MP who is a dr & deals with medical issue in Parliament.
Waiting on a reply.

MPs are all stood down now until after general election results announced.

Cutting inappropriate blood glucose self-monitoring ‘could save NHS £20m’

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