The epetition

[noblehead]

Might be a stupid question (probably is :roll: ) but do all the petitions on the go count collectively or does the target figure have to come from a single source?

 

[Pneu]

Good point Lucy. Bit like the NHS views on "Fat taxes" and "no treatment for smokers", although treatment for heroine addicts is fine. (I don't smoke by the way!) So sensible debate is needed on all this.

Can we take this thread back on track now guys... its about the e-petition for type II test stripes not the merits of funding for type I or type II (which are both equally deserving in most peoples minds...).

On that note, can I ask about the excellent idea of adding a link to the petition on our signature line Pneu? It can't be done. We can add the address, but not a link. I know people can paste and copy, but they're perhaps more likely to respond if there's a direct link.I've written to Benedict asking if there's a way round this, but perhaps you would know?

I don't think you can add links to 'external' sources you would need to discuss with Benedict I am afraid

 

[Pneu]

A Note To All:
Right.. I have made adjustments to a number of posts in this thread... it is not going to turn in to a type I vs type II... I will not tolerate stereotyping against either type I;s or type II's and frankly as a type I who tries to contribute to this community I have irritated by a number of the comments in this thread..

Stereotyping is NOT ACCEPTABLE either way.

Now can we please get back to discussing the e-petition.. A very dim view will be taken on any more people trying to push an agenda of causing arguments between various 'types' we are all diabetics.

 

[Pneu]

Might be a stupid question (probably is :roll: ) but do all the petitions on the go count collectively or does the target figure have to come from a single source?

noblehead that's a very good question.. as I am quite sure there must be similar initiatives and petitions elsewhere.. would make the target more achievable if these could be 'combined'.

 

[shop]

A Note To All:
Right.. I have made adjustments to a number of posts in this thread... it is not going to turn in to a type I vs type II... I will not tolerate stereotyping against either type I;s or type II's and frankly as a type I who tries to contribute to this community I have irritated by a number of the comments in this thread..

Stereotyping is NOT ACCEPTABLE either way.

Now can we please get back to discussing the e-petition.. A very dim view will be taken on any more people trying to push an agenda of causing arguments between various 'types' we are all diabetics.

I agree Pneu,

I have noticed a few times now derogatory comments about T1s. I have signed the petition and would be the 1st to defend a T2 if I heard somone stereotyping a T2 with the Obesity stick ( I am getting tired of hearing it and I am a T1.)

I like to think that we should all support each other. It is not a T1 persons fault that T2's dont get strips but that doesnt mean that I agree with it. I had a tiny example of the control on strips when I asked for 2 lots as I wanted to make sure I had enough when I went on holiday. I really had to explain to the prescriptions lady why in the heat it is possible to use more strips ( hypos and I am trying very hard to stableize my sugars by carb counting.)
I have even halted the decision to do a true basal test ( I am trying to get my dosage right ) partly because of the use of so many strips ( also finding the right time to do it. ) So I am aware of using too many!

I hope that the majority do not start to take it out on the minority who actually are trying to support you!

Lucy.

 

[Grazer]

Might be a stupid question (probably is :roll: ) but do all the petitions on the go count collectively or does the target figure have to come from a single source?

noblehead that's a very good question.. as I am quite sure there must be similar initiatives and petitions elsewhere.. would make the target more achievable if these could be 'combined'.

Only individual petitions count. We did try to liaise to a degree, but DUK weren't interested, ABC got in first (although their effort got only a small number of signatures). So joined up petitioning sadly didn't work.

 

[dawnb64]

Signed it - I couldn't believe how quickly you can get through test strips when you're trying to work out what foods your body can tolerate!! Just ordered another 200.

 

[xyzzy]

While I agree with testing for T2 and have signed the petition it is worth pointing out the arguments being used against testing. This block of text can be found again and again if you search about testing for T2's. On the surface it presents quite a powerful argument for NOT prescribing test strips both in terms of effectiveness and cost.

Two new studies suggest that newly diagnosed people with type 2 diabetes are unlikely to gain any benefits from monitoring their blood glucose themselves. Self-monitoring of blood glucose (SMBG) may also result in a lower quality of life. In people with established type 2 diabetes, SMBG approximately doubles the net health-care costs with no benefits and a decrease in quality of life. SMBG in newly diagnosed patients and those with established type 2 diabetes should now be reserved for certain people treated with insulin and, conceivably, in some very specific circumstances (e.g. patients who are at risk of hypoglycaemia during intercurrent illness or fasting). Instead, we should direct our attention to interventions likely to make a difference to patients’ symptoms and cardiovascular risk, and consider using the resources currently allocated to SMBG to help this. These include support and advice around nutrition, exercise, smoking cessation, foot care, etc.

Action
Patients, health professionals and commissioners of health care should look carefully at the use of SMBG. These two studies cast further doubt on its usefulness in newly diagnosed patients and those with established type 2 diabetes, other than for certain people treated with insulin and, conceivably, in some other very specific circumstances.

More benefit may well come from directing attention to interventions likely to make a difference to patients’ symptoms and cardiovascular risk. It may be worthwhile for commissioners to consider using the resources allocated to SMBG to fund increased focus on support and advice around nutrition, exercise, smoking cessation, foot care, etc. In 2004, it was estimated that around 1.5 million people had type 2 diabetes. If we make a conservative estimate, that SMBG could be discontinued in two-thirds of these, the DiGEM analysis suggests that around £90 million could be found each year to fund such interventions.

What is the background to this?
SMBG is discussed in detail on the type 2 diabetes section of NPC. Although different studies have produced slightly different results, it seems clear that in most people with established type 2 diabetes who are trying to exercise strict glycaemic control with diet or tablets, the long-term effect of SMBG on HbA1c and major clinical outcomes is, at best, modest, may be non-existent or is even harmful.

It has been suggested that, in the recently diagnosed, SMBG may help patients understand more about the implications of food choices, promote adherence to medication and improve satisfaction with treatment. However, this does not seem to have been assessed in a clinical trial until now. In addition, although it is known that the NHS spends more on the prescription costs of SMBG materials than it does on oral hypoglycaemic drugs, there has not been a UK-based cost-effectiveness assessment of SMBG.

What did these studies find?
In people newly diagnosed with type 2 diabetes, O’Kane et al found that adding SMBG (with advice and guidance on how to respond to high or low readings) to a comprehensive, structured, education programme did not produce greater reductions in HbA1c compared with the education programme alone. HbA1c decreased from 8.8% to 6.9% in the SMBG group, and from 8.6% to 6.9% in the control group; the mean differences were not significant at baseline (SMBG vs control -0.33, 95% Confidence Interval (95%CI) –0.77 to 0.51), at 12 months (0.07, 95%CI –0.25 to 0.38) or at 3, 6 or 9 months follow up. There were no differences between the groups in the incidence of reported hypoglycaemia, use of oral hypoglycaemic drugs or Body Mass Index (BMI). The study did not measure differences in clinical outcomes such as rates of cardiovascular events.

Assessments of the patients well-being found that patients in the SMBG group were significantly more depressed than in the control group. There were no statistically significant differences in any other well-being, treatment satisfaction or diabetes attitude measures.

In non-insulin-treated people with type 2 diabetes in the DiGEM study, Simon et al found that SMBG increased annual net costs of care (which include health professional time, prescription costs, hospital care, etc). Average net annual costs were £89 in the no-monitoring group, £181 in the less intensive SMBG group (an extra cost of £92, 95%CI £80 to £103) and £173 in the more intensive SMBG group (an extra cost of £84, 95%CI £73 to £96). SMBG was also associated with a reduced quality of life.

Now to me this just say testing costs a lot and is not particularly effective if the patient is told to follow the standard NHS regime as it stands. It's no wonder people get depressed or no real difference in hBA1c is seen if they're told to stuff themselves full of carbohydrates and then see very little or no improvement in what their meters tells them. The point is T2 testing comes into its own when you use it with a dietary regime that WORKS.

This brings us nicely back to the "Something must be done" and "Eat to you meter" campaigns we are talking about which for those who haven't read the thread can be seen here http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=2&t=29512. This recommends testing along side dietary info that does work. As a pragmatist I think the addition of dietary info is possibly the only differentiator we have to show that it IS worthwhile prescribing strips to T2's regardless of how many signatures are finally obtained on the petition.

So I see the issue of testing for T2 and changing dietary guidelines to be very much one and the same thing.


Finally although late to this thread and only having read it once moderated I would like to add my support to those who have said stereotyping of people of any diabetic type is equally abhorrent and should be actively discouraged. There are hard enough battles to be won by all diabetics without us ending up bitching at each other.

 

[borofergie]

Now to me this just say testing costs a lot and is not particularly effective if the patient is told to follow the standard NHS regime as it stands. It's no wonder people get depressed or no real difference in hBA1c is seen if they're told to stuff themselves full of carbohydrates and then see very little or no improvement in what their meters tells them. The point is T2 testing comes into its own when you use it with a dietary regime that WORKS.

That's an excellent point. Test strips are useless without education and support.

 

[Unbeliever]

It is a great pity in my opinion, that comparatively simple measures to help people control their diabetes have become such an
apparenly complicated ssue.
How hard is it, after all, to add a few lines to any existing hand outs stating that some diabetics find reducing carbohydrates to be very effective in controlling bg levels and pointing them in the direction of further information on how to go about it.
Patients could be asked if they wished to monitor their own bgs to assess the effeciveness of any dietary or other changes made and to establish the effects of different foods on their bg levels.
Again more info could be offfered as necessary.
Follow up could be incorporated into the normal check ups.
As someone who was diagnosed at a time when absolutely no information was give to patients about the best way to use the meters whic were universally distributed , but told instead that this information was purely intended for the doctor even basic info and some element of choice offfered to the patient would be an improvement on the old system and could result in a better outcome.

Forcing meters on everyone and checking the results diary with no explanation was never going to work.
more information and education would be very desirable but also more costly. Just to have some extra options could change lives.
Making the prescription of strips a privilege to be used wisely and effectively should prevent the waste of the past.
It just doesn't seem to me that it needs to be difficult.
iTest strips were once given out freely to all and sundry without any education. Some manged to make them work for themselves .
Giving them only to those wishing to be proactive should not be beyond the realms of possibility and neither should a simple suggestion to reduce carbs . Many HCPs already agree with this. Information about where to find the finer ponts would be available.

Once these points were established they could be built on later.
The NHS constantly completely reverses policies and treatments. These are comparatively small matters. Neither entirely new or unheard of but it is the litle things that matter and have the power to change lives.
Well worth a try More chance of success in the current climate if done subtly.

 

[RoyG]

The thing that puzzles me is why are these things being priced so high, Contour £20.19 on Amazon, what's in them gold or something, again I think greed and profit has a lot to do with it. No wonder they give meters away, they are are on to a win win solution. how do they justify that price. its just the drugs company's charging unfair prices for a product the probably cost about 1p to manufacture. It's them the argument should be levelled at and a petition made up for.

 

[Squire Fulwood]

I am not declaring a passion for Squire Fulwood, although, as an admirer of romantic novels, the name does conjure up certain images in my mind :lol:

At the risk of ruining my image I should explain that I was given my handle by the landlady of a local pub as a reward for all the money I spent there. Sorry to go off topic but I thought it necessary to explain that.

Back to the epetition debate.

 

[Grazer]

I am not declaring a passion for Squire Fulwood, although, as an admirer of romantic novels, the name does conjure up certain images in my mind :lol:

At the risk of ruining my image I should explain that I was given my handle by the landlady of a local pub as a reward for all the money I spent there. Sorry to go off topic but I thought it necessary to explain that.

Back to the epetition debate.

You mean you don't wear riding boots and carry a crop? Lucy will be dissapointed!

 

[Squire Fulwood]

You mean you don't wear riding boots and carry a crop? Lucy will be dissapointed!

Not for some years now since I can't get into the togs. I found my jodphurs in a trunk a while ago and I think they were made to fit a young slim person. I am now no longer slim nor young. Sorry Lucy.

 

[desidiabulum]

It is a great pity in my opinion, that comparatively simple measures to help people control their diabetes have become such an
apparenly complicated ssue.
How hard is it, after all, to add a few lines to any existing hand outs stating that some diabetics find reducing carbohydrates to be very effective in controlling bg levels and pointing them in the direction of further information on how to go about it.
Patients could be asked if they wished to monitor their own bgs to assess the effeciveness of any dietary or other changes made and to establish the effects of different foods on their bg levels.
Again more info could be offfered as necessary.
Follow up could be incorporated into the normal check ups.
As someone who was diagnosed at a time when absolutely no information was give to patients about the best way to use the meters whic were universally distributed , but told instead that this information was purely intended for the doctor even basic info and some element of choice offfered to the patient would be an improvement on the old system and could result in a better outcome.

Forcing meters on everyone and checking the results diary with no explanation was never going to work.
more information and education would be very desirable but also more costly. Just to have some extra options could change lives.
Making the prescription of strips a privilege to be used wisely and effectively should prevent the waste of the past.
It just doesn't seem to me that it needs to be difficult.
iTest strips were once given out freely to all and sundry without any education. Some manged to make them work for themselves .
Giving them only to those wishing to be proactive should not be beyond the realms of possibility and neither should a simple suggestion to reduce carbs . Many HCPs already agree with this. Information about where to find the finer ponts would be available.

Once these points were established they could be built on later.
The NHS constantly completely reverses policies and treatments. These are comparatively small matters. Neither entirely new or unheard of but it is the litle things that matter and have the power to change lives.
Well worth a try More chance of success in the current climate if done subtly.

As usual, Unbeliever, I agree with everything you say. Xyzzy -- this is really helpful -- what is the source of the SMBG piece? It really does clarify what we're up against, and if this is what is being distributed among HCPs it does explain some of the 'testing will drive you insane' remarks that posters have received. As you say, education is the key. All the more reason to proceed with care, and to anticipate objections that would be prompted by readers of the SMBG report.

 

[noblehead]

The thing that puzzles me is why are these things being priced so high

One of life's mystery's Roy. You can understand at the start that the manufacturers need to recovery research costs and this may explain the high prices, many years down the road there is no justification for charging what they do.

 

[Grazer]

The thing that puzzles me is why are these things being priced so high

One of life's mystery's Roy. You can understand at the start that the manufacturers need to recovery research costs and this may explain the high prices, many years down the road there is no justification for charging what they do.

I think the answer is, because they CAN. Bit of cartel stuff going on. I'm hoping the cheap codefree strips will give them something to think about.

 

[Unbeliever]

I have long suspected that they are just riding the storm. They are waiting for things to settle a little in the NHS. I understand from American friends that there diabetics have always had to buy their own strips.
I don't know how the prices compare nowadays but they used to be a bit cheaper. than they were here.
There will always be a market for strips for T1s but maybe this will not be big enough on its own to create a competitive market.
The situation is somewhat confusing as some T2s are prescribed strips , others buy their own or supplement their prescriptions while the message coming from newly qualified Drs and the Nursing colleges , is that self testing is A BAD THING.
I don't think some firms can believe that this once very lucraive market [the NHS} is gone for ever .
At some stage a large manufacturer/distributor will take the plunge and cut prices to a reasonable level.
We may then see a volte face by the NHS. Until then.........

 

[phoenix]

The price here in France is €38.61 for 100 strips, this the negotiated price that the social security will reimburse (and the rate my local pharmacies will sell at, but they can legally charge more).
Type 2s here now get a maximum of 200 strips a year unless they are on insulin. They are only supposed to be prescribed within the context of 'education'. As a T1 I get prescribed 6 a day, though the pharmacist interprets that as 200 per month. I have used more than this,particularly when I first started running long distances, but have bought them myself.

In the US the cost on Amazon varies but about $58-60. (so more than in France) I believe it depends upon the persons insurance on whether they will be prescribed them and how much co-pay is involved.

 

[SophiaW]

This might be a silly suggestion and not something I would want to get involved with as our strips are prescribed for free (daughter has t1). Would it be possible if enough T2's got together to negotiate a better price (maybe like a wholesale price) for bulk purchasing of test strips. It might help to drive down the cost of self-funding for those t2's who buy their own strips, it would take some organising and someone or a group would need to organise and negotiate it all. The codefree strips I believe are cheaper, perhaps the group could negotiate an even better price rather than each person buying individually and paying retail price. I know ultimately t2's should get them free on prescription but perhaps this might serve as a help in the meanwhile as I don't think NHS policy is going to change quickly.