Self monitoring of blood glucose (SMBG)for people with Type 2 is currently restricted, in both local and national recommendations, to those in all but very specific circumstances. We believe this is, at best, unfair and at worst, in complete contravention of current health policies which promote self-responsibility for health, self-management of long term conditions and individualised approaches to care. We believe that all people with Type 2 diabetes should be given the opportunity for SMBG. Here's why:
Type 2 diabetes is a progressive, serious condition which requires for many, considerable lifestyle changes if its dire consequences are to be avoided or detected promptly. For everyone, success in managing their condition depends on daily medication, physical activity, attention to timings, amounts and content of food and drink. Also required is effective and prompt action in the face of stress, illness, driving, holidays, work and social life, short-notice schedule changes, family responsibilities and more. In short, every aspect of daily life.
If people with Type 2 diabetes are to take their condition seriously by doing all this, as many in healthcare say they should, then they need the only practical tool available to them to help, namely SMBG.
1. But this is expensive, say health economists and budget holders: to which we say - but losing 20 years of your life to uncontrolled diabetes is also expensive, as is heart failure, amputation, kidney dialysis and blindness, which are among the most costly and avoidable consequences of not self-monitoring.
2. But people don't know how to use SMBG properly, say health professionals: to which we say - that's your fault for not explaining how it needs to be used and how serious a condition Type 2 diabetes is, and the need for rigorous self management, right from the start.
3. But there's no evidence it improves diabetes control or HbA1c, say researchers and medics: to which we say - most people with Type 2 diabetes aren't solely interested in their HbA1c, indeed many don't even know what this level is. What they are interested in is their everyday life and making this as hassle-free as possible, avoiding hypos and high blood glucose levels which can be inconvenient, embarrassing and even dangerous (e.g. when driving, as most people do). They also wish to see for themselves the positive effects of their strenuous efforts to make lifestyle changes and the choices they make daily, not wait 3 months for the health professional to order a repeat HbA1c.
If we are truly committed to a population of people with Type 2 diabetes effectively self-managing, they must have the tools to do this vital, cost-effective job. It's time to get people with Type 2 testing - or at least give them the choice.