Is fingerstick testing improving T2D outcomes?

[Oldvatr]

Bloody hell thats appalling..!

I am surprised at this, since the NICE guidelines from an early time when I was DX'ed clearly stated that the first steps should be control by diet and lifestyle changes, then introducing drugs if not successful. Ten years ago I was given a meter and strips for 3 months to do SMBG with advice to identify the hard hitters and eliminate them from diet. Then the strips stopped, and I became a junkie.
Section 1.3 of the latest NICE guidelines [NG28] is specifically for diet, but I do note that there is no flowchart showing the diagnosis path where the "start with diet changes" was so clearly delineated. Instead the flowchart starts with individualised care which starts with structured education and lifestyle, which might have diet advice but it is no longer mandatory it would seem. So the role of diet seems to have been demoted in the newer guidelines. However, since this is usually the Eatwell Plate, then maybe this is actually a blessing incognito.

This is the closest they now get to what constitutes a good diet
1.3.3. Emphasise advice on healthy balanced eating that is applicable to the general population when providing advice to adults with type 2 diabetes. Encourage high‑fibre, low‑glycaemic‑index sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include low‑fat dairy products and oily fish; and control the intake of foods containing saturated and trans fatty acids. [2009]

 

[Brewers23]

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.

As an HCP, who also happens to have both hypothyroidism and T2 DM, we are somewhat restricted by NICE guidance. As nurses we have to stay within guidelines, otherwise we are at risk of losing our registration; unlike physicians who can go off piste with little chance of sanctions by the GMC, unless the patient suffers significant harm. The current guidelines currently prevent GPs from prescribing testing strips on a regular basis for T2DM on diet/oral medication (Although a case could probably be made for patients on Gliclazide as this is notorious for inducing hypoglycaemia.). Google 'Self monitoring of blood glucose in non-insulin-treated Type 2 diabetes nhs' and there should be a link to the government web archive. There should also be a link to a letter in the British Medical Journal, and from there there's a further link to the research article itself.
Medical and nursing care is (supposed to be) individualised, patient-centred and evidence based. It is the responsibility of NICE (England/Wales) and SIGN (Scotland) to look through the evidence, and based on that evidence provide guidance for best practice. In general HCPs do not have the time to sift through all of the conflicting evidence themselves, there are simply not enough hours in the day, and so we are completely dependent on others doing this for us. One thing that is apparent from the papers that appear to support regular BM testing for non-insulin T2DM is that it HAS to be supported by educational support from the HCP.