I can't help. I know it's going to have flow-on effects here eventually, so I wish you well. I think you are going to need concerted efforts by many others in other forums to win this one. I'll repeat this post on asd, asd.uk and mhd.
Here is just one excerpt from the drivel: "Conclusion This paper suggests that many patients with type 2 diabetes are selfmonitoring blood glucose unnecessarily, at a cost to the NHS of £17 million annually. Much of this money could be saved by improving management for patients taking metformin or insulin plus oral therapy.
It is not possible from these data to estimate what proportion of testing was appropriate."
Wow Alan!!!!! How short-sighted can people become?
If there is anyone out there who hasn't added their support to my e-petition on this subject on 10 Downing Street then perhaps now is the time to do it. Moreover, get friends and family to add their support too. There are 355 supporters so far but we need to get this up to at least 500 to ensure that 10 Downing Street are certain to respond.
Immediate response in relation to having that thrown at me would be:
"My testing is appropriate. Here's my data, conclusions and Jennifer's testing protocol to show you the methodology behind it, which as much as the accountants would love you to, you can't actually argue effectively against. Now shut up and write my repeat scrip"
If that didn't work, I would have to go into a half hour critique of DIGEM and ESMON, comparing it with testing methodologies that do work ie. Jennifer. Then point out to the doc that the testing methodology which does waste money is what they originally suggested to me so perhaps they could actually suggest a testing methodology to new patients which is effective instead of wasting NHS funds.
You seem to have gone a bit red in the face, Doc. Are you all right?
Thanks Alan. Its depressing, but good to be forewarned.
This paper suggests that many patients with type 2 diabetes are selfmonitoring blood glucose unnecessarily, at a cost to the NHS of £17 million annually. Much of this money could be saved by improving management for patients taking metformin or insulin plus oral therapy.
I've managed to convince my GP that the opposite is the case. After initially having refused to prescribe strips and strongly advising against the necessity for a Type 2 to test, when he saw what I had achieved in less that twelve months by testing and changing my diet accordingly, he now prescribes strips for me on a regular basis because "It's cheaper than prescribing insulin". His words - not mine! I added that it is also cheaper than dealing with laser eye treatment, amputations, kidney dialysis, heart operations etc, etc. He nodded his head in agreement.
When will we ever convince the rest?
T2 Diag. Nov 2000 - Then HbA1c 5.7, Chol 7.0, BP 164/109. Metformin 2000mg > 1000mg; Simvastatin 40mg > 20mg; Ramipril 1.25mg; Bisoprolol 5mg > 2.5mg > 1.25mg; Aspirin 75mg. HbA1c progression following NHS advice: 5.7 > 6.7 > 7.4 > 8.2 > 9.4 > 7.2 > 6.7 > 8.5% HbA1c progression by self-management: 8.5 - 6.8 > 5.7 > 5.5 > 5.3 > 5.3 > 5.1 > 5.0% TC 3.7; TG 0.93; HDL 1.52; LDL 1.8 BP now averages around 115/70 Weight Loss: 118kg to 85kg
Of course this is based on a purely economic analysis of the potential savings that could be made if the published guidance was followed more closely.
In other words, what would be saved if the NICE guidelines, as interpreted by the parties involved and translated into a notional strip allocation, were followed to the letter. As such, it is unconcerned with clinical outcomes or the notion that doctors should be able to treat patients on an individual basis according to their needs.
It even explicitly says : " It is not possible from these data to estimate what proportion of testing was appropriate." And by implication it doesn't care. This is about money, not medical need, after all.
Of course the NICE guidelines include "to assess changes in glucose control resulting from medications and lifestyle changes." But the subsequent guidance from all sides on the number of strips required takes no account of lifestyle at all, only considering monitoring legitimate to check the effects of medication so amendments may be made to that.
In individual cases, if this study is used as a stick with which to beat diabetics, I reckon the best counter-argument derives from the "study limitations" where the authors acknowledge:"...it seems unlikely that such high proportions of some treatment groups would meet the NICE criteria for nonroutine use." If someone can show that they are using the NICE criteria (for lifestyle changes, as per Nige and John's responses) then the economic argument advanced here against non-NICE sanctioned testing should not apply.
T1 DX 06/2003 using Lantus and Novorapid. Dafne graduate.
Ziggy. T2 Since 22-May-2008 Chol:- May 09 Total Chol - 5.3, HDL - 1.53, LDL - 2.23, Trigs - 2.93 / Dec 09 Total Chol - 5.1, HDL - 1.49, LDL - 2.76, Trigs - 1.86 Ramapril 10mg, Omeprazole 20mg Exercise and Diet (am a lacto ova vegetarian and am trying to stay low GI/GL)Still on the Road To Find Out
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