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Self-monitoring of blood glucose (SMBG) in type 2 diabetes These slides should be used in conjunction with the accompanying notes

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Self-monitoring of blood glucose (SMBG) in type 2 diabetes These s should be used in conjunction with the accompanying notes Options for local implementation NPC. – PowerPoint PPT presentation

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Title: Self-monitoring of blood glucose (SMBG) in type 2 diabetes These slides should be used in conjunction with the accompanying notes


1
Self-monitoring of blood glucose (SMBG) in type
2 diabetes These slides should be used in
conjunction with the accompanying notes
2
Options for local implementationNPC. Key
therapeutic topics 2010/11 Medicines management
options for local implementation. Second update
July 2011
  • Review and, where appropriate, revise local use
    of SMBG in type 2 diabetes mellitus to ensure
    that it is in line with NICE guidance

3
Key questions
  • What does NICE say about SMBG in type 2 diabetes?
  • What is the evidence for SMBG in type 2 diabetes?
  • Are there specific groups of patients with type 2
    diabetes who would benefit from SMBG?
  • How are we doing with prescribing?

4
Type 2 diabetes management is multifactorial
Smoking
Control blood pressure
Education
Lifestyle
Control blood glucose
Individualised care of patients based on
evidence for each intervention
Statin
Aspirin
Metformin
These slides should be used in conjunction with
the accompanying notes
5
What does NICE say about SMBG in type 2
diabetes? NICE Clinical Guideline 87 May 2009
  • Make available to
  • Those on insulin
  • Those on oral medication to provide information
    on hypoglycaemia
  • Assess changes during medication or lifestyle
    changes, or illness
  • Ensure safety during activities, including
    driving.
  • Assess at least annually in a structured way
  • Self-monitoring skills
  • Quality and appropriate frequency of testing
  • The use made of results obtained
  • The impact on quality of life
  • The continued benefit
  • The equipment used.

6
  • What is the evidence for SMBG in
  • type 2 diabetes?

7
HTA report on SMBG in type 2 diabetesClar C, et
al. HTA 2010 Vol. 14 No. 12
  • Identified 30 RCTs, although few of high quality
  • Concluded that evidence suggests SMBG is of
    limited clinical effectiveness in improving
    glycaemic control in people with type 2 diabetes
    on oral agents, or diet alone, and is therefore
    unlikely to be cost-effective
  • SMBG may lead to improved glycaemic control only
    in the context of appropriate education both
    for patients and healthcare professionals on
    how to respond to the data, in terms of lifestyle
    and treatment adjustment
  • SMBG may be more effective if patients are able
    to self-adjust drug treatment
  • Further research is required on the type of
    education and feedback that are most helpful,
    characteristics of patients benefiting most from
    SMBG, optimal timing and frequency of SMBG, and
    the circumstances under which SMBG causes anxiety
    and/or depression.

8
More evidence for SMBG in type 2
diabetes?Polonsky, WH, et al. Diabetes Care
2011342627, MeReC Rapid Review No. 2534
  • US 12-month RCT of 483 poorly controlled
    insulin-naïve type 2 diabetic patients (mean
    HbA1c 8.9)
  • Compared a comprehensive, structured SMBG
    intervention package (which encouraged patients
    and doctors to work together to collect,
    interpret, and appropriately use SMBG data) with
    enhanced usual care
  • Primary end point HbA1c at 12 months
  • Significantly greater reductions in mean HbA1c
    with structured SMBG compared with enhanced usual
    care
  • mean reduction in HbA1c 1.2 vs. 0.9,
    respectively, P0.04
  • Unclear whether 0.3 difference in HbA1c between
    groups is clinically significant and enough to
    justify the additional resources needed to
    provide the intervention

9
  • Are there specific groups of patients
  • with type 2 diabetes who would benefit
  • from SMBG?

10
NHS Diabetes Report on SMBG in non-insulin
treated patients with type 2 diabetesNHS
Diabetes. March 2010. http//www.diabetes.nhs.uk/p
ublications_and_resources/reports_and_guidance/
  • SMBG should be available (with appropriate
    structured education) to people receiving
    sulfonylureas to identify hypoglycaemic episodes
  • SMBG should only be provided routinely to people
    not treated with insulin or sulfonylureas where
    there is agreed purpose
  • SMBG should be used only within a care package,
    accompanied by structured education, with regular
    review
  • individuals with non-insulin treated diabetes who
    are motivated by SMBG activity and use
    information to maximise effect of lifestyle and
    medication should be encouraged to continue to
    monitor
  • staff training in the use of SMBG to support
    changes in lifestyle and self-adjustment of
    medications is required
  • savings from reduction in SMBG should be used to
    provide structured education and training of
    professionals.

11
How are we doing with prescribing? http//www.ic.n
hs.uk/pubs/prescribingdiabetes0410
COST
12
Key messages
  • Management of type 2 diabetes requires
    individualised multifactorial care
  • In patients with established type 2 diabetes
    whose blood glucose is relatively well-controlled
    with oral drugs who monitor blood glucose
    infrequently, little is to be gained in promoting
    SMBG, even with an education programme
  • Reserve SMBG for people treated with insulin and
    in some specific circumstances
  • such as patients at risk of hypoglycaemia during
    intercurrent illness, fasting or when using
    sulfonylureas
  • Attention and resources may be best directed to
    interventions likely to make a difference to
    patients symptoms and risk of macrovascular and
    microvascular complications
  • such as support and advice around nutrition,
    exercise, smoking cessation, foot care,
    management of blood pressure and lipids
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