The update summarises the current guidelines from the National Institute for Health and Clinical Excellence (NICE) for type 1 and type 2 diabetes with respect to self-monitoring of blood glucose (SMBG). NICE recommend that, in patients with type 1 diabetes, SMBG should be offered as part of an integrated care package. In patients with type 2 diabetes NICE recommend SMBG should be taught if the need and/or purpose are clear and agreed with the patient.
The update recommends that in patients with type 1 diabetes or insulin-treated type 2 diabetes that SMBG is an integrated part of self-care and that testing frequency will be reliant upon the patient and their insulin regimen.
It is also recommended that in patients with non-insulin treated type 2 diabetes routine monitoring is not required and that six monthly HbA1c should be used to monitor glucose control. This recommendation is based upon the inconclusive findings of two meta-analyses and a systematic review comparing SMBG with other strategies in reducing HbA1c.
The update therefore suggests that during a medication reviews the following questions should be considered:
- What action is prompted by the results of self-monitoring of blood glucose?
- If no action can be taken, what value does self-monitoring add to the patient's care?
Finally, the update reveals that approximately 25% of NHS spending on diabetes is funding self-monitoring test strips. A reduction in inappropriate prescribing of these strips will release funds to reinvest in other areas of care.
Action: All clinicians involved in the care of patients with diabetes should be aware of the cost of self-monitoring test strips. Reducing inappropriate use of these strips will release funds and allow the NHS to invest in other areas of care.
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