There’s been a flurry of diabetes-related reports, guidelines and activity in the last few weeks, kicked off with the release of the new NICE guidance for Type 2 diabetes at the start of December. Hotly debated in its draft stages, the guidance was delayed by the need to re-work some of the recommendations as a result
However eggy-faced this might have made the authors, the result is hugely improved and more importantly, will probably benefit people with Type 2 diabetes and professionals alike to a much greater degree
It’s not perfect by any means. Foremost in our minds here at SD, is the disastrously limited use for personal blood glucose monitoring, about which we have expressed concern before on this blog. However, the authors and guideline committee have clearly listened to their critics, and allowed a much greater freedom of choice, for example of which medication class to use as treatment intensifies. They’ve also very helpfully articulated exactly what education programmes should comprise and when these should be offered. And at least, the topic of self-blood glucose monitoring in Type 2 diabetes is recommended for more research. So, good – as far as it goes
Of course, no guideline is of any use at all unless it’s followed – so take a look at the full thing and see whether it applies to your life or work with Type 2, or check out our ’10 Guideline Headlines’ for an overview to whet your appetite.
Elsewhere, Diabetes UK reported recently that diabetes numbers are ever growing, and have now topped 4 million, with the majority having Type 2 diabetes and people with this form are becoming younger and younger at diagnosis. This knowledge is bittersweet – on the one hand it focuses the minds of policy makers and the NHS alike, but on the other, to world-weary, longstanding diabetes campaigners and organisations, it brings a huge temptation to shout ‘I told you so!’, as they recall so many other warning reports that this would in fact, come to pass, and feel sad that these warnings were not heeded
But we are where we are, and so the recent report of the Public Accounts Committee of the UK Government, concluding that diabetes is costing the nation far too much and there is far too much variance in the standards of care, shines a welcome light on what needs to be done urgently, albeit the cry of ‘again’ might be heard from some quarters
Just today, it’s been announced that the All Party Parliamentary Group (APPG) for Diabetes will be hosting an international diabetes conference in Parliament on 3rd February, with the aim of sharing best practice in diabetes and raising awreness. It’s open to attendance by people living and working with diabetes alike, providing a welcome chance for these groups to meet each other on common ground. That’s an opportunity not often seen, despite grand rhetoric about collaboration and partnership in care. Despite the short notice, this is likely to be a buzzing event and something new and different to herald what looks likely to be a landmark year for diabetes developments.
Judging by the way it’s started, there’s every reason to hope this new year diabetes flurry becomes a full-on storm! Bring it on
References
Management of Type 2 Diabetes in Adults
Type 2 Diabetes – Time to Test?”
SD Downloads
Number of People with Diabetes Reaches Over 4 Million
Diabetes: Government and NHS Too Slow to Act, say MPs
APPG to Host International Diabetes Conference in UK Parliament
Tuesday, 26 January 2016
Monday, 4 January 2016
Bongs and Gongs: But Aren’t We All Winners?
When the bongs sound at midnight at the end of the year, one thing about the year to come is already known – who has received a New Year Honour, as typically these are announced on or around New Year’s Eve
Last year was no exception and it was absolutely delightful to hear that a prominent professor of diabetes and the chair of one of Diabetes UK’s local groups had both been awarded a national medal. Both are extremely well deserved and we offer them our hearty congratulations
When congratulated, recipients almost always say the award is not just for them but for the people they work with and for. This seems to be especially true for diabetes, which requires so much more than personal input, but also the support and contribution of many others, whether diabetes is personal or professional. Obviously not everyone can get a medal - and nor would everyone want one
What’s indisputable, however, is that where honours are accepted, they give a wonderful opportunity to highlight diabetes and its self care and medical care needs, and to put the people who live and work to improve both experience and outcomes firmly in the spotlight. Many people work hard in the cause of diabetes and in that sense we are all winners – those honoured help to show that
Wishing everyone the honour of a Happy and Healthy New Year!
Last year was no exception and it was absolutely delightful to hear that a prominent professor of diabetes and the chair of one of Diabetes UK’s local groups had both been awarded a national medal. Both are extremely well deserved and we offer them our hearty congratulations
When congratulated, recipients almost always say the award is not just for them but for the people they work with and for. This seems to be especially true for diabetes, which requires so much more than personal input, but also the support and contribution of many others, whether diabetes is personal or professional. Obviously not everyone can get a medal - and nor would everyone want one
What’s indisputable, however, is that where honours are accepted, they give a wonderful opportunity to highlight diabetes and its self care and medical care needs, and to put the people who live and work to improve both experience and outcomes firmly in the spotlight. Many people work hard in the cause of diabetes and in that sense we are all winners – those honoured help to show that
Wishing everyone the honour of a Happy and Healthy New Year!
Tuesday, 10 November 2015
8757 or 8760 - What’s the Difference?
Diabetes is a self managed condition. You live with it 24/7 and make decisions about how to manage it during that time. If you’re lucky, you receive help, support and learning, both informal and formal, from your nearest and dearest, other people with diabetes, diabetes health services and organisations. But it’s still yours every day.
Campaigns like the recently launched ‘Taking Control’ by Diabetes UK highlight how important the education side of things is, helping people to understand more and learn the skills to make those daily decisions. ‘SD Comments’ has talked many times about the tiny numbers of people who actually receive such learning opportunities, even though they are recommended for everyone, So, we’re really pleased to see this campaign get off the ground, support it wholeheartedly, and wish it every success. There is just one thing, however…..
…and that is, the first sentence of the introduction to the campaign reads ‘..people with diabetes only spend around three hours with their doctor, nurse or consultant. For the other 8757 hours, they must manage their condition themselves’. This implies that when someone with diabetes is consulting, somehow the responsibility for their diabetes belongs to the health professional they are with.
It’s not deliberate, but this is another example of what might be called ‘unconscious paternalism’ – the idea that it’s ok for ‘patients’ to do their own thing unless they are under the jurisdiction (ie in the consulting room) of a health professional.
Apart from being at odds with the personalised care policy, the push for greater collaboration between health professionals and people with diabetes and promotion of self care, this assumption also makes the mistake of thinking that the health professional being consulted actually knows what is best for the person. They may be valued experts in diabetes, but not in living with diabetes and particularly not in an individual’s life with diabetes, not on that day, in that hour, or ever. Nor should they try or expect to be.
What’s needed is for this oft-trotted statistic to be reflected upon. Is this really what we want those numbers to mean? We suggest not. It’s perfectly valid to count the hours (or lack of them, some would say) that someone spends with a health professional, It’s also perfectly valid to consider how well these hours are used to promote and support self management and daily decision making. What’s not valid is to perpetrate the unconscious but well-rehearsed assumption, however well-meant, that really, it’s the health professional who matters most, who is somehow ‘in charge’
People with diabetes are perfectly capable of looking after their diabetes within a consultation as outside it, 8760/8760. The job of the consultation is to reflect and work together on the experiences these hours raise for the person themselves, so that they are equipped to make each one of them a success
Reference
Diabetes UK’s Taking Control Campaign
Campaigns like the recently launched ‘Taking Control’ by Diabetes UK highlight how important the education side of things is, helping people to understand more and learn the skills to make those daily decisions. ‘SD Comments’ has talked many times about the tiny numbers of people who actually receive such learning opportunities, even though they are recommended for everyone, So, we’re really pleased to see this campaign get off the ground, support it wholeheartedly, and wish it every success. There is just one thing, however…..
…and that is, the first sentence of the introduction to the campaign reads ‘..people with diabetes only spend around three hours with their doctor, nurse or consultant. For the other 8757 hours, they must manage their condition themselves’. This implies that when someone with diabetes is consulting, somehow the responsibility for their diabetes belongs to the health professional they are with.
It’s not deliberate, but this is another example of what might be called ‘unconscious paternalism’ – the idea that it’s ok for ‘patients’ to do their own thing unless they are under the jurisdiction (ie in the consulting room) of a health professional.
Apart from being at odds with the personalised care policy, the push for greater collaboration between health professionals and people with diabetes and promotion of self care, this assumption also makes the mistake of thinking that the health professional being consulted actually knows what is best for the person. They may be valued experts in diabetes, but not in living with diabetes and particularly not in an individual’s life with diabetes, not on that day, in that hour, or ever. Nor should they try or expect to be.
What’s needed is for this oft-trotted statistic to be reflected upon. Is this really what we want those numbers to mean? We suggest not. It’s perfectly valid to count the hours (or lack of them, some would say) that someone spends with a health professional, It’s also perfectly valid to consider how well these hours are used to promote and support self management and daily decision making. What’s not valid is to perpetrate the unconscious but well-rehearsed assumption, however well-meant, that really, it’s the health professional who matters most, who is somehow ‘in charge’
People with diabetes are perfectly capable of looking after their diabetes within a consultation as outside it, 8760/8760. The job of the consultation is to reflect and work together on the experiences these hours raise for the person themselves, so that they are equipped to make each one of them a success
Reference
Diabetes UK’s Taking Control Campaign
Tuesday, 20 October 2015
Should There be Sugar Everywhere?
The campaign to encourage the UK Government to tax sugary soft drinks stepped up a notch this week, with Jamie Oliver continuing his quest at the Houses of Parliament, first with the Health Select Committee and then with the All Party Parliamentary Group (APPG) on Diabetes. He reckons the tax will raise up to £1bn and also change the nations habits and choices towards low sugar varieties of fizzy drinks or water. Jamie’s leading by example in his own restaurants, by making sugary drinks more expensive than ‘diet’ varieties.
Whether this will even be adopted, much less work, remains to be seen. A new tax, particularly on a ‘pleasure’ related activity, may not be popular with the all-important voters. And might it smack of ‘nanny state-ism’, trying to organize the behaviour of the population, rather than allowing them to choose for themselves what is good for them and their families? Discussion boards are full: of ‘righteous restrainers’, who ask why they should pay more tax just because others cannot control themselves in relation to calories, as well as ‘generous gifters’, who see the benefits to all – dental, environment, economic – of a change in availability of so much sugar – and everything in between. Public opinion is divided.
On the other hand, it’s undeniable that we are in the middle of a resolutely ticking, weight-related time bomb, set to go off at any time and unleashing untold illness, misery, and expense to the NHS among middle aged and younger people. Some say there is a generation alive now, who will be the first to die before their parents, because of the wrath of Type 2 diabetes, cardiovascular disease and immobility, caused by excess calories, of which they are largely unaware because of (allegedly) limited labelling and ruthless marketing on the part of the giant fast food industries
How can these issues be resolved in the interests of everyone? One thing’s for sure, this will not be a ‘one solution fits all’ situation – tax sugary drinks and all will be well. Equally, we believe strongly that people are the best decision makers for themselves, given the information they need to weigh up their choices. So there needs to be a much wider range of information and approaches. Here are some of our ideas to contribute to a way forward:
The National Prevention Programme for Type 2 Diabetes needs to be heavily involved in messages about the seriousness of Type 2 diabetes and the possibility of its prevention, directed at everyone, rather than to those immediately at risk. There are still too many myths about Type 2, including ‘it comes on in later life’ and ‘it’s only the mild form’. The nation’s psyche in this respect needs all the help it can get to change.
Fast food, ready made food and drinks companies need to invest in much clearer labelling to help people make choices – Jamie Oliver’s suggestion that sugar content is shown in spoonfuls rather than grams, for example, would make much more sense to every buyer as they can envisage those spoonfuls being added.
Comparison tools (maybe linked to the self-scanners on trolleys or on the shop floors?) to be freely available in food stores . These would show the relative sugar content of different products by name, so that people can make on the spot choices while actually shopping. These comparator tools could also be online or even (remember the old ways?) in pictorial leaflet –form, but would be most important in-store, where the shopping head is in full control.
The answer to the question this blog poses? There can be sugar everywhere, but it doesn‘t mean we have to eat it. Other substances are also available – as long as we know it!
Reference
Be Bold on Sugar Tax, Jamie Oliver Says
Jamie Oliver meets with Diabetes UK at Parliament
Whether this will even be adopted, much less work, remains to be seen. A new tax, particularly on a ‘pleasure’ related activity, may not be popular with the all-important voters. And might it smack of ‘nanny state-ism’, trying to organize the behaviour of the population, rather than allowing them to choose for themselves what is good for them and their families? Discussion boards are full: of ‘righteous restrainers’, who ask why they should pay more tax just because others cannot control themselves in relation to calories, as well as ‘generous gifters’, who see the benefits to all – dental, environment, economic – of a change in availability of so much sugar – and everything in between. Public opinion is divided.
On the other hand, it’s undeniable that we are in the middle of a resolutely ticking, weight-related time bomb, set to go off at any time and unleashing untold illness, misery, and expense to the NHS among middle aged and younger people. Some say there is a generation alive now, who will be the first to die before their parents, because of the wrath of Type 2 diabetes, cardiovascular disease and immobility, caused by excess calories, of which they are largely unaware because of (allegedly) limited labelling and ruthless marketing on the part of the giant fast food industries
How can these issues be resolved in the interests of everyone? One thing’s for sure, this will not be a ‘one solution fits all’ situation – tax sugary drinks and all will be well. Equally, we believe strongly that people are the best decision makers for themselves, given the information they need to weigh up their choices. So there needs to be a much wider range of information and approaches. Here are some of our ideas to contribute to a way forward:
The National Prevention Programme for Type 2 Diabetes needs to be heavily involved in messages about the seriousness of Type 2 diabetes and the possibility of its prevention, directed at everyone, rather than to those immediately at risk. There are still too many myths about Type 2, including ‘it comes on in later life’ and ‘it’s only the mild form’. The nation’s psyche in this respect needs all the help it can get to change.
Fast food, ready made food and drinks companies need to invest in much clearer labelling to help people make choices – Jamie Oliver’s suggestion that sugar content is shown in spoonfuls rather than grams, for example, would make much more sense to every buyer as they can envisage those spoonfuls being added.
Comparison tools (maybe linked to the self-scanners on trolleys or on the shop floors?) to be freely available in food stores . These would show the relative sugar content of different products by name, so that people can make on the spot choices while actually shopping. These comparator tools could also be online or even (remember the old ways?) in pictorial leaflet –form, but would be most important in-store, where the shopping head is in full control.
The answer to the question this blog poses? There can be sugar everywhere, but it doesn‘t mean we have to eat it. Other substances are also available – as long as we know it!
Reference
Be Bold on Sugar Tax, Jamie Oliver Says
Jamie Oliver meets with Diabetes UK at Parliament
Tuesday, 29 September 2015
Old Things in New Ways?
The promotion of self-management of diabetes by the person with the condition themselves is not new. As far back as the 1940s, when insulin was relatively new in town and medications for Type 2 diabetes were hardly thought of, a young doctor called Robin Lawrence wrote in his book ‘The Diabetic Life’ – ‘the patient must be at once his own doctor, dietitian and lab technician’. This urge and acceptance that diabetes is absolutely a self-managed condition somehow got lost over proceeding decades, when health professionals tended to take charge of both medications and expectations
More recently there’s been a massive upsurge in ‘people power’ in society generally. The expectation and indeed, often, political will, is that people will do things for themselves. We are our own cashiers in the supermarket, our own bankers and even our own hotel receptionists. This upsurge has been replicated in medicine, not least because most illnesses these days are the long term variety, such as diabetes, that people have to manage themselves each day. This is well recognised, being mentioned in health policy documents as well as official guidelines and enacted in practical situations such as GP’s clinics and hospital wards. Indeed, our own work here at SD is all about promoting success in living with diabetes
Given this situation, the news this week that a major international meeting of the great and the good of diabetes care and education, held here in the UK, had formed an alliance which resolved to make diabetes care more person centred and promote self management, would seem rather unnecessary. Surely things are going in the right direction already? Do we need another layer of ‘initiative’ in this direction?
The truth is, as we’ve no doubt said before, that there is a lot of TALK about promoting self-management and being person-centred, but often the ‘old ways’ – a rather paternalistic approach, people being ‘told off’ for not achieving text book results, scant regard for the emotional turmoil which many people experience their diabetes, etc etc – persist, even supported by protestations that ‘the patients need me to tell them what to do, otherwise they wouldn’t know’
Hence a new, eye-catching way of promoting this way of being in relation to helping people really run their own condition has got to be good. The words might not be new, but the actions could reflect new times to come. We await this Alliance’s progress with our full support
Talking of old and new, SD is changing its ways this week, too. 30th September 2015 sees the last issue of our monthly newsletter, which has been running since 2008. Our refreshed communication plan is to make much more use of the instant means available to us, to update much more often using the 21st century tools of social media, Facebook, Twitter and the like – and add more frequent, but shorter, comment on the blog here. The need to communicate is as old as the hills, but the ways of doing it can be ever newly minted!
References
The Diabetes Times: Alliance formed to promote diabetes self management
More recently there’s been a massive upsurge in ‘people power’ in society generally. The expectation and indeed, often, political will, is that people will do things for themselves. We are our own cashiers in the supermarket, our own bankers and even our own hotel receptionists. This upsurge has been replicated in medicine, not least because most illnesses these days are the long term variety, such as diabetes, that people have to manage themselves each day. This is well recognised, being mentioned in health policy documents as well as official guidelines and enacted in practical situations such as GP’s clinics and hospital wards. Indeed, our own work here at SD is all about promoting success in living with diabetes
Given this situation, the news this week that a major international meeting of the great and the good of diabetes care and education, held here in the UK, had formed an alliance which resolved to make diabetes care more person centred and promote self management, would seem rather unnecessary. Surely things are going in the right direction already? Do we need another layer of ‘initiative’ in this direction?
The truth is, as we’ve no doubt said before, that there is a lot of TALK about promoting self-management and being person-centred, but often the ‘old ways’ – a rather paternalistic approach, people being ‘told off’ for not achieving text book results, scant regard for the emotional turmoil which many people experience their diabetes, etc etc – persist, even supported by protestations that ‘the patients need me to tell them what to do, otherwise they wouldn’t know’
Hence a new, eye-catching way of promoting this way of being in relation to helping people really run their own condition has got to be good. The words might not be new, but the actions could reflect new times to come. We await this Alliance’s progress with our full support
Talking of old and new, SD is changing its ways this week, too. 30th September 2015 sees the last issue of our monthly newsletter, which has been running since 2008. Our refreshed communication plan is to make much more use of the instant means available to us, to update much more often using the 21st century tools of social media, Facebook, Twitter and the like – and add more frequent, but shorter, comment on the blog here. The need to communicate is as old as the hills, but the ways of doing it can be ever newly minted!
References
The Diabetes Times: Alliance formed to promote diabetes self management
Tuesday, 18 August 2015
No Judgement Please – We’re Doing our Best!
Recently, two unrelated publications, one an Australian blog and the other a UK peer-reviewed medical journal, have given voice to the same topic. Their different and highly complementary views combine to offer a powerful message, close to the heart of many with diabetes as well as ours here at SD.
On 7th August, Renza Scibilia wrote her daily blog about living with diabetes as if it were a letter to a diabetes doctor in a new clinic. It started with the words ‘you and I are on the same side. My side’, then continued expressing the hope of partnership, of mutual understanding and the absence of judgement about her life with diabetes. Above all, she expressed the desire for recognition that even when diabetes isn’t going too well in her life, that she is always doing her best.
Her message is clear: respect my expertise and I’ll respect yours, so we can have a great and useful relationship. This post attracted a number of comments, including one from a diabetes educator who said ‘you have helped me become a better clinician’. It occurred to us that the idea of a ‘letter of introduction’ such as this, should perhaps be an option in all clinics, to help break down the assumptions, myths and negative judgements that, however inadvertently, often underlie the consultation words from a health professional towards and about the person with diabetes.
Which helps to introduce the second publication, from the respected journal ‘Diabetic Medicine’. In the first study of its kind, the authors interviewed parents of children with Type 1 diabetes about the challenges of keeping their children’s blood glucose in range, in the context of their everyday lives.
Apart from the surprise that such a qualitative study had not been undertaken before now, there were two major new findings in this paper – one being that parents often had ‘home’ and ‘away’ blood glucose targets – the latter being more relaxed than the former. This reflects the desire to ensure their child was safe from hypoglycaemia and able to enjoy the event they were attending without their parents. It also showed their recognition that other care givers at events would not have the detailed knowledge that they had about the intricacies of diabetes-related actions and their own child’s condition. This in itself was hugely moving, the parents wishing ‘a normal life’ for their child and reassurance for themselves that hypoglycaemia, an ever present fear for parents, was unlikely outside of their direct care.
The second finding was in relation to consultations with health professionals, who, although excellently reviewed in terms of knowledge of diabetes and its treatment, were universally found to expect a ‘text-book’ achievement of recommended HbA1c levels, without apparently realising the realities and complexities of life with diabetes that the parents had to face. It seemed to be summed up in the comment by one parent ‘you’ve tried really hard…and you get ‘oh their HbA1c is not good enough, you need to do better’. In this single sentence, the sense of demoralisation, frustration and unrecognised effort rings out.
Unsurprisingly, one of the conclusions of the paper is that health professionals need to be more empathic, more recognising of effort as well as results and have a training that engages in the everyday detail of living with diabetes as well as the medical and scientific knowledge which currently prevails.
What are we saying here by bringing these two pleas together? Quite a simple message really, one for health professionals as they invite people living with diabetes into their consulting rooms, and one which is really quite easy and cheap to achieve. It’s summed up by something a colleague of ours said many years ago ‘always remember to honour effort as well as outcomes’.
It’s only the sheer effort and doing their best by people who are in the complex maelstrom that diabetes can present in life, that gets any outcome at all. And the only judgement that effort deserves, is a massive ‘well done’ at each and every visit. Please, just do it.
References
Diabetogenic: Dear Doctor: 7 August 2015
Lawton, J., Waugh, N., Barnard, K., Noyes, K., Harden J., Stephen, J., McDowell, J., Rankin, D. (2015). Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents’ experiences and views. Diabetic Medicine , 32, 1063-1070
On 7th August, Renza Scibilia wrote her daily blog about living with diabetes as if it were a letter to a diabetes doctor in a new clinic. It started with the words ‘you and I are on the same side. My side’, then continued expressing the hope of partnership, of mutual understanding and the absence of judgement about her life with diabetes. Above all, she expressed the desire for recognition that even when diabetes isn’t going too well in her life, that she is always doing her best.
Her message is clear: respect my expertise and I’ll respect yours, so we can have a great and useful relationship. This post attracted a number of comments, including one from a diabetes educator who said ‘you have helped me become a better clinician’. It occurred to us that the idea of a ‘letter of introduction’ such as this, should perhaps be an option in all clinics, to help break down the assumptions, myths and negative judgements that, however inadvertently, often underlie the consultation words from a health professional towards and about the person with diabetes.
Which helps to introduce the second publication, from the respected journal ‘Diabetic Medicine’. In the first study of its kind, the authors interviewed parents of children with Type 1 diabetes about the challenges of keeping their children’s blood glucose in range, in the context of their everyday lives.
Apart from the surprise that such a qualitative study had not been undertaken before now, there were two major new findings in this paper – one being that parents often had ‘home’ and ‘away’ blood glucose targets – the latter being more relaxed than the former. This reflects the desire to ensure their child was safe from hypoglycaemia and able to enjoy the event they were attending without their parents. It also showed their recognition that other care givers at events would not have the detailed knowledge that they had about the intricacies of diabetes-related actions and their own child’s condition. This in itself was hugely moving, the parents wishing ‘a normal life’ for their child and reassurance for themselves that hypoglycaemia, an ever present fear for parents, was unlikely outside of their direct care.
The second finding was in relation to consultations with health professionals, who, although excellently reviewed in terms of knowledge of diabetes and its treatment, were universally found to expect a ‘text-book’ achievement of recommended HbA1c levels, without apparently realising the realities and complexities of life with diabetes that the parents had to face. It seemed to be summed up in the comment by one parent ‘you’ve tried really hard…and you get ‘oh their HbA1c is not good enough, you need to do better’. In this single sentence, the sense of demoralisation, frustration and unrecognised effort rings out.
Unsurprisingly, one of the conclusions of the paper is that health professionals need to be more empathic, more recognising of effort as well as results and have a training that engages in the everyday detail of living with diabetes as well as the medical and scientific knowledge which currently prevails.
What are we saying here by bringing these two pleas together? Quite a simple message really, one for health professionals as they invite people living with diabetes into their consulting rooms, and one which is really quite easy and cheap to achieve. It’s summed up by something a colleague of ours said many years ago ‘always remember to honour effort as well as outcomes’.
It’s only the sheer effort and doing their best by people who are in the complex maelstrom that diabetes can present in life, that gets any outcome at all. And the only judgement that effort deserves, is a massive ‘well done’ at each and every visit. Please, just do it.
References
Diabetogenic: Dear Doctor: 7 August 2015
Lawton, J., Waugh, N., Barnard, K., Noyes, K., Harden J., Stephen, J., McDowell, J., Rankin, D. (2015). Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents’ experiences and views. Diabetic Medicine , 32, 1063-1070
Wednesday, 29 July 2015
Type 2 - Time to Test?
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.
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.
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