There has already been a petition on the Number 10 petitions site about availability of test strips in response to a news story that intimated that NICE were going to change their recommendations regarding Self Monitoring of Blood Glucose (SMBG), the response was typical spin where Government said that it was a clinical decision and therefore nothing to do with Government.
NICE recommendations on SMBG are quite clear and there needs to be a lot more pressure from patients and patient organisations like DUK on individual PCTs to ensure that NICE recommendations are met.
I hate to bang on about the Diabetes NSF, but its still five years in and the variability in support for people with diabetes across SHAs and PCTs is still shockingly apparent and there was at least one early day motion in the last session of Parliament that bemoaned that fact.
DUKs position on SMBG is very clearly defined
here. As I understand it DUK support the NDSTs recommendations on SMBG for type 2s which I tried to explain in
this thread
Ann Keen, Parliamentary Under-Secretary of State at the Department of Health, has said in response to a letter I wrote last year that
Any PCT which is automatically discouraging the prescription of blood glucose testing strips is not acting in according with NICE's advice that self-monitoring may prove useful to people in their overall approach to self-care.
I think the argument for SMBG for type 1s and for those type 2s on sulfonylureas is very clearly understood by clinicians, the danger to the patient when hypoglycaemic is a very compelling argument.
However, I think DIGEM clearly demonstrates that clinicians don't really understand how people with diabetes can use SMBG when making lifestyle choices about diet and exercise. There was a session at the recent DUK conference in Glasgow discussing the evidence for and against SMBG for type 2s - I did volunteer to go along and give a five minute overview of how SMBG has helped me get my BG under better control and therefore helped my practice meet one of its targets - unfortunately I am not a healthcare professional and might have come under the sway of any number of medical sales representatives and done untold harm to myself and was therefore not allowed to make the presentation I wanted to.
Finally, there are ways to apply pressure, I have recently joined my
Local Involvement Network (
Direct.Gov's explanation here)- one the roles of which is to ensure that health and social care provision meet the community's needs, and although it is a voluntary body it has statutory powers under the
Local Government and Public Involvement in Health Act 2007.
Quite clearly we as patients have responsibility to make best use of SMBG, there is at least one story on this site of one person buying test strips across ebay from a patient who had been prescribed them - clearly not the best way to convince clinicians that we are making best use of the tools that they reluctantly make available to us.
I've made a point in another thread about
Shared Decision Making (SDM), it's all about patients being given enough information to make decisions about their treatment that will suit their lifestyle, rather than having treatment foisted upon them by those suffering from a God complex, I really do view SMBG as being a decision aid that allows me to decide treatment options for my condition on a daily basis. There have already been two trials of SDM in England, one in Cambs led by Dr. Mary Archer (
Urology Informed Decision Making project) and another led by Dr. Steve Laitner (
Informed Decision Making for osteoarthritis of the knee). Politically speaking we've been led to believe that the choice agenda is all about getting treatment when we want it where we want it, the fact that we should be able to influence what treatment we receive has been slightly obfuscated (and I wouldn't necessarily say that the obfuscation has been deliberate). There is a whole host of evidence out there that demonstrates that SDM leads to better outcomes, we just to need to rob some of our health care team members of their deity complexes :roll:
One final thing I would like to point out is
Information Prescriptions, this is a little known facility, where we can get information about our condition and the treatment we should expect to receive from the NHS as well as the facilities in our area that can help us manage our condition. One of the Long Term Conditions where the facility is available is diabetes. I would argue that the dietary information needs to be more encompassing, however that is a long uphill battle we still have to fight.
