December 26, 2012

Joslin Advocates for SMBG

This is an interesting turn of events. Normally I am the one complaining about the lack of self-monitoring of blood glucose, but now Joslin Diabetes Center is asking in their book Joslin's Diabetes Deskbook, 2nd Ed, Excerpt #4: Do Your Patients Self-Monitor Their Blood Glucose Enough? For this, I have to ask if they will appeal to the Centers for Medicare and Medicaid Services (CMS) to up the number of test strips that diabetes patients can be reimbursed.

I complain because people do not test enough and use the results to help manage their diabetes in as more informed manner. I appreciate Joslin's statement, It is imperative that people who are self-monitoring know what to do with the results of their glucose checking so that they can take active steps to improve their control. They should be given instructions on how to interpret their results, what they can do themselves in response to the results, and when they should call for help.” At least the authors know and understand the importance of education and that it should be part of every diabetes treatment plan.

Too many doctors do not even prescribe a meter and test strips for patients on oral medications, meaning patients with type 2 diabetes. This excerpt should be required reading for these self-important doctors. All doctors do either give out meters and prescribe test strips or inform their patients where to obtain testing supplies for people with type 1 diabetes and for people with type 2 diabetes on insulin.

I like what is covered in chapter 3. They state that, “Goals of diabetes treatment need to be defined in terms of self-monitoring results.” This is a great statement, which patients with diabetes need to understand. This brings both patients and physicians into the picture and makes each a participant. The patients are responsible for gathering the information, doing this diligently, and providing this information to the physicians. Then the physicians are responsible for taking this information and helping the patients set goals (whether new or revised) to help then manage their diabetes more effectively.

In summary, here are a few reasons why SMBG should be performed:
1. To provide data about glucose patterns that can be used by the healthcare team, working with the patient, to make treatment manageable.
2. To provide data with which patients themselves can make daily decisions on treatment adjustments.
3. To provide feedback on how effectively the individual is managing daily self-care routines, including medical nutrition therapy, physical activity, and medication use.

These are by no means the only reasons and the tables uses are adapted from the American Diabetes Association and are therefore not ideal, but can only be interpreted as suggestive for patients that are elderly or have other diseases, which affect their ability to manage their diabetes more effectively. Those patients that are younger and fully able to manage their diabetes need to consider using these tables.

Another area of concern is a few of the “diabetes coaches” that tell their people not to give the information to their doctors. Granted some doctors do not know what to do with the information, but they are on their way out of practice as patients become more empowered. I have crossed paths with a few of these “coaches” and know they are attempting to hide what they are doing. Not that they are giving out advice that is out of line, but too often these “coaches” are practicing medicine without a license. They may not have intended to, but they do cross the line time after time.

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