Presentation Transcript

1. Blood glucose self-monitoring in type 2 diabetes mellitus Emma Harris Medicines Management Pharmacist West Suffolk Clinical Commissioning Group Educational Event 28th January 2014 West Suffolk Hospital Education Centre
2. WSCCG Prescribing Data Total spend on all BGTS by 10% No.4 on the WSCCG Rx Recommendation Top 10 savings areas (excluding PIP metrics) Potential 12-month saving of £92,442 T2DM not treated with insulin
3. NICE CG87: The management of type 2 diabetes Self-monitoring of plasma glucose should be available to: those on oral glucose-lowering medications to provide information on hypoglycaemia assess changes in glucose control resulting from medications and lifestyle changes monitor changes during intercurrent illness ensure safety during activities, including driving
4. NICE CG87 Assess at least annually & in a structured way: self-monitoring skills the quality and appropriate frequency of testing the use made of the results obtained the impact on quality of life the continued benefit the equipment used
5. Medical Standards of Fitness to Drive Drivers Medical Group, DVLA, Swansea (2013)
6. (2012) “Drivers with a Group 1 licenceon insulin have been advised to test their blood glucose before driving. If this practice were to be encouraged in people on sulphonylureas, it would increase enormously the cost of blood glucose monitoring.”
7. Greatest risk of hypoglycaemia in first 3 months of sulphonylurea treatment Maintain current practice Extra testing only in those people who are starting treatment experiencing hypoglycaemia or reduced awareness
8. For Group 1 drivers (car/motorcycle) the frequency of blood glucose monitoring should depend on the clinical context A Group 2 driver (bus/lorry) on a sulphonylurea or glinide is required by law to monitor blood glucose at least twice daily and at times relevant to driving
9. Position Statement on Self monitoring of blood glucose (SMBG) for adults with Type 2 diabetes (April 2013) Exact role of SMBG in Type 2 diabetics not on insulin less clear and widely debated Volume & cost of Rx for monitoring rising SMBG should be available to people receiving sulphonylurea and prandial glucose regulators Access to SMBG based on individual assessment Arbitrary withdrawal of SMBG in those who clearly benefit should not occur
10. Reflect on practice Responsibility to use resources wisely Education, appropriate and timely reviews, responding to results Support those who find SMBG useful Identify those who gain no benefit SMBG performed indefinitely? Testing for a defined period may be appropriate
11. Type 2 diabetes mellitus treated with: These medicines can cause hypoglycaemia Blood glucose monitoring may therefore be required in patients: who are not stabilised on treatment who are drivers in other certain circumstances
12. Type 2 diabetes mellitus treated with: Diet and exercise alone Regular blood glucose monitoring not necessary A supply of blood glucose test strips may be required (as an acuteprescription) in certain circumstances
13. Blood glucose monitoring may be required in patients: with acute illness up to 7 days post-surgery co-prescribed steroids undergoing significant changes in pharmacotherapy or fasting at increased risk of hypoglycaemia/hypo unawareness with unstable or poor glycaemic control (HbA1c >8.0%) with postprandial hyperglycaemia who are pregnant or planning pregnancy
14. Clinical judgement Choice of treatment DVLA Seek advice Repeat vs. acute prescription Regular review Suitable quantities to meet patient needs, prevent stockpiling and waste Patient education How frequently should my patient test their blood glucose? How many test strips should I prescribe?
15. Questions