If the purpose of this research1 is to create cost-cutting opportunities for the NHS then I can still not applaud it. Diabetes UK’s position statement on self-monitoring of blood glucose (SMBG) for adults with type 2 diabetes states ‘The Department of Health, the pharmaceutical industry and commissioners of services should together review the cost of testing strips and together negotiate a reduction in cost to the NHS’.2 This point would, in my opinion, offer a more realistic and balanced approach to financial savings than this article.
Writing as a type 1 diabetic I would like to highlight my concerns with this study. First, how can the researchers know what effectiveness their study had on the health of those participating if they did not continually measure it? If there is a necessity for SMBG in those at risk of hypoglycaemia, what about those at risk of hyperglycaemia; for example, the majority of type 2 diabetics? Did the removal of SMBG from those participating have an adverse effect on blood glucose levels and lead to an increased rate of complications and cost of treatment?
Then, the authors state that patients report that use of SMBG can be associated with feelings of blame or failure, and disappointment when clinicians are disinterested in readings. Does this mean SMBG does not work? What about the patients who exercise good control through a knowledge of what impact the food they eat has on their blood glucose levels? This is only possible through SMBG. Feelings of pride, control and motivation when the individual is successful and when the clinician is interested are equally important.
This study sought to offer a cost reduction in the NHS budget, not to implement NICE guidance. There is no concern for the benefits to the patient. Withdrawing the availability of SMBG will not address the issue of poor implementation and, until such time as there is proper implementation, the effectiveness of SMBG for any diabetic will not be properly recognised.
The key to diabetes treatment is in empowering the patient; in making the patient take ownership and control of their condition. To do that requires the appropriate tools.
- © British Journal of General Practice 2015
