Restricting glucose strips sending wrong message: experts

By Jennie James

2 Nov 2015

Moves to restrict access to blood glucose testing strips for most people with type 2 diabetes is sending the wrong message about the value of structured self-monitoring of blood glucose, three leading Australian diabetes experts warn.

In a Perspective published in today’s MJA Professor Jane Speight and from the Australian Centre for Behavioural Research in Diabetes and colleagues say that at face value, restricting access implies that some forms of diabetes require less monitoring and are, therefore, less serious than others.

“Yet all diabetes is serious and all diabetes leads to complications if not monitored and managed appropriately,” they wrote.

The authors acknowledge that the studies used to support the restricted access policy concluded that “clinical benefit is limited” for SMBG in people with non-insulin-treated T2D, but argue that the way SMBG is conducted is vital to its efficacy as a method for improving the health of people with T2D.

Random, low frequency, routine SMBG is “unstructured”, they say, and ineffective because it doesn’t enable people with T2D or health professionals to detect blood glucose level patterns or act upon them.

But when SMBG is structured, for example seven checks per day over three consecutive days in the week before seeing a doctor, the findings are more positive, they said.

This is because patterns can be seen, discussed and inform action to improve glucose levels, they explained.

Studies have shown that structured SMBG is associated with reduced HbA1c levels, less glycaemic variability overall, less time spent in hyperglycaemia and important psychological benefits, such as increased satisfaction with treatment and greater confidence in, and motivation for, diabetes self-care.

“Health professionals need to look beyond the headlines and appreciate the importance of quality over quantity when it comes to monitoring,” Professor Speight told the limbic.

“Monitoring is not an end in itself and there is no dose response. But well-timed SMBG is a powerful and unexploited tool. It enables people to visualise the impact of meals and physical activity on blood glucose and to make informed decisions about their self-management.”

The authors note that a person with non-insulin-treated T2D using structured SMBG could use as few as 84 test strips per year, which suggests great potential for the government’s restricted access policy (100 strips over six months) to be applied sensibly.

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