|Guidance on Blood Glucose Testing and use of Testing Strips|
|Further guidance NICE NG28|
|Measurement of HbA1c
> In adults with type 2 diabetes, measure HbA1c levels at:
3–6-monthly intervals (tailored to individual needs), until the HbA1c is stable on unchanging therapy
> 6-monthly intervals once the HbA1c level and blood glucose lowering therapy are stable
|Self-monitoring of blood glucose
Take the Driver and Vehicle Licensing Agency (DVLA) At a glance guide to the current medical standards of fitness to drive into account when offering self‑monitoring of blood glucose levels for adults with type 2 diabetes.
Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes unless:
the person is on insulin or
>there is evidence of hypoglycaemic episodes or
>the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery or
>the person is pregnant, or is planning to become pregnant. For more information, see the NICE guideline on diabetes in pregnancy. [new 2015]
Consider short-term self-monitoring of blood glucose levels in adults with type 2 diabetes (and review treatment as necessary):
>when starting treatment with oral or intravenous corticosteroids or
>to confirm suspected hypoglycaemia.
Be aware that adults with type 2 diabetes who have acute intercurrent illness are at risk of worsening hyperglycaemia. Review treatment as necessary.
If adults with type 2 diabetes are self‑monitoring their blood glucose levels, carry out a structured assessment at least annually. The assessment should include:
>the person's self-monitoring skills
>the quality and frequency of testing
>checking that the person knows how to interpret the blood glucose results and what action to take
>the impact on the person's quality of life
>the continued benefit to the person
>the equipment used.
|CHOICE OF COST EFFECTIVE STRIPS|
Somerset CCG recommends the use of devices which use strips not exceeding £10 per 50 strips. There are over 30 to choose from, all offering similar ranges and accuracy to more expensive strips. Blood glucose meters are not available at NHS expense, and prescribers are not obliged to supply expensive strips just because a manufacturer has supplied a certain meter. This applies both to type 1 and type 2 diabetics. Some type 1 diabetics may require more specialised meters, but many will only require basic testing capability.
|See here for a list of approved strips|
|Freestyle Libre -flash glucose monitoring system-RESTRICTED USE ONLY
Freestyle Libre should ONLY be an option for patients with type 1 diabetes (>4yrs old)
* Who have demonstrated that they are well motivated to manage all of the clinical risks associated with their condition (not just HbA1c) and are also educated to respond to the information provided by Freestyle Libre.
* The patients GP believes that a clinical need will be fulfilled by the provision of Freestyle Libre in motivating the patient to achieve and maintain better clinical outcomes.
* The patient’s GP believes that the patients current use of blood glucose testing strips will be reduced by the use of Freestyle Libre.
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