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<blockquote data-quote="Oldvatr" data-source="post: 1766634" data-attributes="member: 196898"><p>Nice sentiment, but while the NHS is funded the way it is, then it will always be fighting the fires, and never able to support preventative measures. There are, to be blunt, no resources available to allow doctors either the time or the tools to do this since their eyes are always on the clock like a chess master. Even when presented with opportunities to save the NHS money long term, their short term goals prevent them taking it up.</p><p></p><p>For exaample, take T2D self monitoring initiative (SMBG). Three years ago I was being referred for insulin therapy since my bgl was going offscale, I managed to persuade my GP to fund my SMBG habit for a month, which I would use to take control. If I succeeded he would support me long term, else I go on the needle. I succeeded in this argument by pointing out that if I fail then the overal cost to the NHS of training, support, medication and kit, togther with an increased risk of either hypo or DKA requirimg A&E admission, and long term increased risk of amputations etc would be very significant. He said yes. but..... the funding for insulin dependancy would not come from his GP budget, but the cost of the meter and consumables did, so for him I was increasing his costs. So I countered this with the obvious parry - that as an ID patient, I would be using more test strips per day than I do as a T2D on orals, so there was negative equity in his argument. I still get my SMBG support, but that may change tomorrow when I get my annual review with my latest HbA1c being 42.</p><p></p><p>My experience with SMBG has been very effective, and if this was extended to more T2's then the NHS would save in the long term. It won;t suit everybody, but should be an option to be offered when HbA1c is above a certain threshold, i,e for a condition that is clearly going down the pan, and where the patient is showing a desire to take back control. Secondly there needs to be better support for lifestyle and diet issues, anf that could be just some simple literature handed out when DX has been confirmed. It could even be just a list of websites or books to read on a sheet of paper, with warnings about Dr Google etc. Not everybody needs an expensive course like DESMOND when only on orals, ID needs are more complex and frightening so do benefit from tuition.</p></blockquote><p></p>
[QUOTE="Oldvatr, post: 1766634, member: 196898"] Nice sentiment, but while the NHS is funded the way it is, then it will always be fighting the fires, and never able to support preventative measures. There are, to be blunt, no resources available to allow doctors either the time or the tools to do this since their eyes are always on the clock like a chess master. Even when presented with opportunities to save the NHS money long term, their short term goals prevent them taking it up. For exaample, take T2D self monitoring initiative (SMBG). Three years ago I was being referred for insulin therapy since my bgl was going offscale, I managed to persuade my GP to fund my SMBG habit for a month, which I would use to take control. If I succeeded he would support me long term, else I go on the needle. I succeeded in this argument by pointing out that if I fail then the overal cost to the NHS of training, support, medication and kit, togther with an increased risk of either hypo or DKA requirimg A&E admission, and long term increased risk of amputations etc would be very significant. He said yes. but..... the funding for insulin dependancy would not come from his GP budget, but the cost of the meter and consumables did, so for him I was increasing his costs. So I countered this with the obvious parry - that as an ID patient, I would be using more test strips per day than I do as a T2D on orals, so there was negative equity in his argument. I still get my SMBG support, but that may change tomorrow when I get my annual review with my latest HbA1c being 42. My experience with SMBG has been very effective, and if this was extended to more T2's then the NHS would save in the long term. It won;t suit everybody, but should be an option to be offered when HbA1c is above a certain threshold, i,e for a condition that is clearly going down the pan, and where the patient is showing a desire to take back control. Secondly there needs to be better support for lifestyle and diet issues, anf that could be just some simple literature handed out when DX has been confirmed. It could even be just a list of websites or books to read on a sheet of paper, with warnings about Dr Google etc. Not everybody needs an expensive course like DESMOND when only on orals, ID needs are more complex and frightening so do benefit from tuition. [/QUOTE]
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