The battle continues.

[catherinecherub]

Yet another review to say there is no good evidence for self monitoring in non insulin diabetics.

These sorts of articles are what makes up the minds of our providers. Keep an eye on the article and see how many comments from G.P.'s are in our favour. :roll: :crazy:
I think they are getting their stats from non compliant patients. We are in the minority in proving that this is not so.

http://www.pulsetoday.co.uk/newsarticle ... n-diabetes

 

[noblehead]

Articles like that make the fight for test strips all the harder!

 

[phoenix]

I don't think it's the articles fault Nigel. Unfortunately it's a Cochrane review and these are considered to be 'gold standard' in evidence based medicine.
If there is any glimmer of hope it is for the newly diagnosed. The full review concludes

With the present findings it can be concluded that self-monitoring of blood glucose (SMBG) in newly diagnosed type 2 diabetes patients who are not using insulin is beneficial in lowering HbA1c. However, when diabetes duration is over one year, the overall glycaemic effects of SMBG are small at short-term and subside after one year. Despite possible glycaemic benefits we conclude that SMBG has no relevant effect on general well-being and health-related quality of life.

They also suggest that more research into the possible benefits of self monitoring

Qualitative research (Farmer 2009; Peel 2007) suggests that SMBG and its feedback can be important factors for individual patients to improve medication adherence, empower the patient to gain control over their disease or to motivate 'lifestyle' changes. Future studies should investigate whether SMBG attributes to other parts of self-management. In addition, SMBG postulated positive changes in diabetic complications should be investigated as well. Furthermore, more research is needed to explore the psychological impact of SMBG and its accompanying demands on diabetes specific quality of life and well-being

http://onlinelibrary.wiley.com/doi/10.1 ... .pub3/full

 

[Sid Bonkers]

I dont quite understand the study or rather the way it has been set up.

The Cochrane review looked at 12 randomised controlled trials including 3,259 patients with diabetes not using insulin who self-monitored their blood glucose.

They found only a small statistically significant decrease in HbA1c at six month follow-up - of 0.3% - compared to control groups of patients who did not monitor at all. By 12-months, there was no significant decrease (0.1%)

Say I had been a test subject or any other well controlled diabetic for that matter, over the course of 12 months I would show no improvement whatsoever as my HbA1c's are always in the 5%'s (fingers crossed). If they had taken their test subjects from out of control diabetics and educated them in diet and carb control and using their meters to achieve better control the results would have been quite different.

So just like all statistics they found the answer they were looking for, no surprises then :roll: :evil:

 

[Unbeliever]

The Gp's comments below the article were very telling weren't they? Very typical too I shoiould think.I wonder if the price of test strips dropped dramatically would we again be told we MUST test?

I accep the fact that resricting the issue of free test strips to all T2 mus appear jusifiable o most GPs given this sort of "evidence" . At least that makes some sort of sense. I cannot understand how anyone can jusify denying an adequate number of strips o T1s.

What does annoy me is the "Why would you want to prick your fingers " comment. A Rookie GP asked me his quite recently {apparently she knew beter than he consultaant} I replied that if I didn't I would find myself pricking my fingers and other parts of my anatomy on a far more regular basis when administering tthe insulin which would be necessary if I was unable to self-monitor the ondition. I wasn't even asking for strips or even talking about diabetes. In my Practice one cannot speak to the Gos about diabetes but hey feel free to lecure the patients apparently.

 

[Grazer]

+1 on Sid's post. The conclusion of the study could equally have been that as results didn't differ, the training given to diabetics on the use of strips and analysis/action was inadequate.

 

[phoenix]

I dont quite understand the study or rather the way it has been set up.

The Cochrane review looked at 12 randomised controlled trials including 3,259 patients with diabetes not using insulin who self-monitored their blood glucose.

They found only a small statistically significant decrease in HbA1c at six month follow-up - of 0.3% - compared to control groups of patients who did not monitor at all. By 12-months, there was no significant decrease (0.1%)

Say I had been a test subject or any other well controlled diabetic for that matter, over the course of 12 months I would show no improvement whatsoever as my HbA1c's are always in the 5%'s (fingers crossed). If they had taken their test subjects from out of control diabetics and educated them in diet and carb control and using their meters to achieve better control the results would have been quite different.

So just like all statistics they found the answer they were looking for, no surprises then :roll: :evil:

sorry Sid, I don't see that your objection holds, It could perhaps be levelled at the Duran study (average 6.7%) but this was one of those with positive findings" http://onlinelibrary.wiley.com/doi/10.1 ... 081.x/full
There were 12 very different studies included and they had subjects with average HbA1cs varying from 6.7% -11.7%

 

[viviennem]

Phoenix posted:

There were 12 very different studies included and they had subjects with average HbA1cs varying from 6.7% -11.7%

I wonder what would happen if they did a study on people with average HbA1Cs in the 5s and asked them how they did it, and what role self-testing played in their control?

I once volunteered for a study in this region and was turned down because my HbA1C was too low!

I would have liked to post a comment on the original link site, but didn't want to join. It would be good to refer them to this forum.

Viv 8)

 

[phoenix]

Phoenix posted:

There were 12 very different studies included and they had subjects with average HbA1cs varying from 6.7% -11.7%

I wonder what would happen if they did a study on people with average HbA1Cs in the 5s and asked them how they did it, and what role self-testing played in their control?

I once volunteered for a study in this region and was turned down because my HbA1C was too low!

I would have liked to post a comment on the original link site, but didn't want to join. It would be good to refer them to this forum.

Viv 8)

It would be interesting but it is anecdote. It wouldn't appear in a Cochrane review, it wouldn't have much influence as evidence. The most reliable type of evidence is considered to come from randomised controlled trials.
http://en.wikipedia.org/wiki/Evidence-based_practice

 

[Sid Bonkers]

sorry Sid, I don't see that your objection holds, It could perhaps be levelled at the Duran study (average 6.7%) but this was one of those with positive findings" http://onlinelibrary.wiley.com/doi/10.1 ... 081.x/full
There were 12 very different studies included and they had subjects with average HbA1cs varying from 6.7% -11.7%

I still think that if those studies had used diabetics who had some insight into how and why they were testing the results would have been very different, I accept that random testing apart from telling you what your current bg level is isn't going to help to gaining control but when linked to diet it is key in my opinion to gaining control of your bg levels.

 

[Pneu]

Phoenix posted:

There were 12 very different studies included and they had subjects with average HbA1cs varying from 6.7% -11.7%

I wonder what would happen if they did a study on people with average HbA1Cs in the 5s and asked them how they did it, and what role self-testing played in their control?

I once volunteered for a study in this region and was turned down because my HbA1C was too low!

I would have liked to post a comment on the original link site, but didn't want to join. It would be good to refer them to this forum.

Viv 8)

Viv this one will make you smile!

I volunteered for a study around diabetic control in long term type I's... I can't remember what it's exact aim was something along the lines of "a study into the methods of control used by successful type I's"... So having completed the initial sign up I had a call from one of the researchers who thanked me for my time but said my control was to good?! How you can have to good control in a study that's whole aim was to access the methods that worked I will never know

 

[Pneu]

I also have to agree with Sid... what these studies seem to do is to take a range of people with moderate to poor control (HbA1c's of 6.7% - 11.7%) and look so see if what they are doing works... what are they expecting the results to be? Clearly the people with moderate control are doing some things that work and those with poor control aren't?!

Surely the best way is as Sid suggests.. you look at the sample of people that are maintaining good control and establish the what commonalities are?

If you wanted to build a really strong building you wouldn't start by looking at buildings that fell over regularly?! you would look at other strong buildings and work out what made them strong?

 

[phoenix]

I also have to agree with Sid... what these studies seem to do is to take a range of people with moderate to poor control (HbA1c's of 6.7% - 11.7%) and look so see if what they are doing works... what are they expecting the results to be? Clearly the people with moderate control are doing some things that work and those with poor control aren't?!

Surely the best way is as Sid suggests.. you look at the sample of people that are maintaining good control and establish the what commonalities are?

If you wanted to build a really strong building you wouldn't start by looking at buildings that fell over regularly?! you would look at other strong buildings and work out what made them strong?

Surely what they are doing is taking 2 groups of matched subjects, giving one group instructions to test at particular times, some trials also included some element of education ... some had quite a bit. The other group is left as a control. (they may share some on the education so both groups are equal)
They then look at the results after a predetermined period. Is there a significant improvement in results when compared to the control group.

Sids design could create an hypothesis... we think this could work. It would then need an RCT on naive subjects to test it.

 

[xyzzy]

However, when diabetes duration is over one year, the overall glycaemic effects of SMBG are small at short-term and subside after one year. Despite possible glycaemic benefits we conclude that SMBG has no relevant effect on general well-being and health-related quality of life.

I thought that was an interesting observation. Although it might be a self defeating statement for me to make I can possibly see why that might be true of Type 2.

Look at it this way. If you are diagnosed Type 2 and take it very seriously and can either afford to test or get the strips supplied by the gp then because you are taking it seriously you will test as you recognise the benefits. At the start like me you will have to test a lot to get your control control and a sensible range of meal options (whatever you individually decide is sensible). Gradually as you get better then the need to test should decline both for physical BG and psychological reasons so after 1 year if you're well controlled then as a bog standard Type 2 you shouldn't really need to test that much and thus there then wouldn't be an effect on

general well-being and health-related quality of life.

as they say the study suggest.

Maybe this accounts in many ways for the "turnover" in active members on the forum. As time progresses they either vanish because they've gone off the rails or vanish because they're now in good control. It would be interesting to analyse who was making majority of posts on the forum this time last year, two years ago etc.

Still doesn't alter the fact that I think if you show your gp or whoever that you are taking things seriously at your first or second DSN appointment you should be prescribed strips but maybe for no more than one year or so. At the moment 2 to 3 months in from diagnosis I know logically I could be testing less but also know that psychologically I'm dependent on testing at present. That psychological issue is one of the things that at the moment I wonder how I'm going to solve as I don't really want to be sticking pins in my fingers 7 times a day for the rest of my life so in many ways a year sounds good to me!

 

[Camilla]

Yet another review to say there is no good evidence for self monitoring in non insulin diabetics.

These sorts of articles are what makes up the minds of our providers. Keep an eye on the article and see how many comments from G.P.'s are in our favour. :roll: :crazy:
I think they are getting their stats from non compliant patients. We are in the minority in proving that this is not so.

http://www.pulsetoday.co.uk/newsarticle ... n-diabetes

Dreadful rubbish! From the day I was diagnosed, even though my GP told me 'no need to test', I began testing. I discovered plenty of reasons to adjust my diet because I could see what was spiking me. Over several weeks and months I controlled my carbs, took exercise and changed my lifestyle directly because of testing. As a result I now have a normal blood sugar level most of the time. That would have been impossible without purchasing my own meter and taking control of my own health. I sincerely hope I will never have to go on tablets. My GP did not discourage me but nor did he encourage me to test. He is just doing what he is told are his guidelines. I am doing what is best for me.

 

[the_anticarb]

As they say in management 'If you can't measure it, you can't manage it'. I always know when my diabetes is/was out of control as it would be the times when my testing metre was gathering dust on the shelf from lack of use. In fact, whenever I want to tighten up my control now, I just test more and that has the psychological effect of changing my behaviour as i don't want to see those big numbers.