Type 2 diabetes

Diabetes educator calls for more education around SMBG for health professionals

Whether or not you agree with the recent changes to the NDSS subsided test strips for people with diabetes not treated with insulin, it’s hard to argue with Sydney-based diabetes educator George Baker, who suggests it’s not about getting more meters into people’s hands but about using them more effectively.

Mr Barker, a Credentialled Diabetes Educator at Hornsby Ku-Ring-Gai Hospital in Sydney presented the findings of his Master’s research study to delegates at the ADS-ADEA Annual Scientific Meeting on the Gold Coast this month.

His study involved qualitative semi-structured interviews with 25 Australian healthcare practitioners (including diabetes educators, dietitians, pharmacists, endocrinologists and general practitioners) to obtain insight into their beliefs and practices relating to self monitoring blood glucose (SMBG) in patients with non-insulin treated type 2 diabetes.

His interest in the area began after he stumbled across a study showing that in patients not treated with insulin, self-monitoring was associated with higher HbA1c levels and psychological burden.

“It got me thinking about my own practice” he told the limbic.

As he looked further at the research he discovered that although blood glucose monitoring had been a feature of diabetes management for decades the evidence that it led to improved glycaemic control in this group was not overwhelming.

Much of the research that did show benefits was funded by pharmaceutical companies supplying blood glucose meters.

“It’s interesting to see how we got to a point that most people were expected to monitor when there’s not much evidence in the literature to support the benefits,” he said.

“The idea of my research was to see how health professionals form their views if it doesn’t come from research”.

“Many people don’t understand where monitoring started and how it evolved into an industry”, he added.

Mr Barker found widely varying opinions within and between health professional groups. This, he pointed out, is not helpful for the person with diabetes, who is often given conflicting advice from the various health professionals they see.

Most of the health professionals he interviewed couldn’t recall any formal education or training on structured self-monitoring.

This is an area he feels needs to be addressed and recommends that both the person with diabetes who has their NDSS form signed, and the health professional who signs the form, need education.

“If you give people a monitor you have a responsibility to help them to use it effectively”, Mr Barker said.

He suggests we need a consistent set of training modules developed by impartial professional organisations be made available to all health professional groups.

“My view about monitoring for those not using insulin has changed over the years”, Mr Barker told the limbic.

“Blood glucose monitoring is not benign – it’s hard to choose those who won’t be negatively affected by it”, he said. “Particularly in those who are anxious, it can cause increased worry and stress”.

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