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Diabetes: Blood Glucose Monitoring
03 March 2004
Volume 658
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asked Her Majesty's Government:

Whether blood glucose monitoring guidelines for people with diabetes are applied throughout the United Kingdom; and whether they intend to enforce new guidelines issued by the National Prescribing Centre to primary care trusts which make reductions in the level of home-based blood glucose monitoring.

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My Lords, both the National Prescribing Centre and the National Institute for Clinical Excellence made it clear in the advisory information and guidelines which they issued respectively in 2002 that self-monitoring of blood glucose can play a positive role in enabling people with diabetes to manage their conditions effectively and constantly. That approach has been reinforced by the Diabetes National Service Framework, which places a strong emphasis on education, information and integrated care.

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My Lords, given that testing blood sugar levels leads to good diabetic control and, hence, saves money for the NHS in the long run, will the Government issue new guidance to GPs and primary care trusts confirming their unambiguous support for home-based training? Will my noble friend also tackle the problem of postcode prescribing of test strips, as reported by Diabetes UK, of which I am a member?

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My Lords, I shall deal with the last point first. We understand that the guidance issued by the National Prescribing Centre raised some questions about the overall usefulness of self-monitoring through blood testing outside a programme of self-management and self-care. However, we want to emphasise that, when it is combined with educational support for patients, self-monitoring plays a very important—indeed, critical—role. That point was brought out strongly in the NICE guidelines. Any PCT which tries to discourage doctors from recommending the use of blood-test strips is, in fact, acting contrary to NICE's own guidance on this matter and, indeed, contrary to the most recent statements of the National Clinical Director for Diabetes.

I turn to my noble friend's first point concerning whether we would ask NICE to issue new guidelines. NICE reviews its guidelines on a three-yearly basis as a matter of course. It will be doing so in 2005 and will certainly take into consideration any new evidence.

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My Lords, the Minister's remarks about self-monitoring warmed up as she answered the questions raised by the noble Lord, Lord Harrison. However, has she had time to consider Mr Wanless's significant report, which emphasises the importance of self-monitoring and the benefits that can be obtained from it? Does the noble Baroness agree that the Department of Health needs to warm up somewhat unless it wants to pick a fight with the Treasury?

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My Lords, I should tell the noble Lord that I do not need any warming up; I am quite hyperactive enough as it is. But he is right to draw attention to the emphasis that the Wanless report places on diabetes. It made it a case study in chronic self-management, and rightly so because 1.3 million people are affected by the condition and it is possible that another 1 million have not even been diagnosed. The report emphasised the importance of self-management and self-care as part of the Diabetes National Service Framework. As my right honourable friend in the other place emphasised, it is important to give people the information to make the right choices.

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My Lords, I ask this question as an insulin-dependent diabetes sufferer. Can the noble Baroness say whether the Government recognise the devastating impact that diabetes can have on every aspect and every facet of one's life? Is there continued awareness of the benefits of education, early diagnosis and strict ongoing monitoring from the perspective of both the patient and the cost to the National Health Service?

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My Lords, I know that there are many experts in this House on the condition of diabetes. The noble Lord was absolutely right in everything that he said. It is a devastating condition which brings many different complications, although it is hoped that many of them can be avoided with preventive measures. The Diabetes National Service Framework placed a huge emphasis on the need for patient education. Indeed, the clinical director recently told us that self-monitoring and learning how to act on the results must go hand in hand if people with diabetes are to live healthy lives. Essentially, we are trying to put that preventive strategy in place.

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My Lords, can the Minister clarify the position with regard to any guidelines issued by the National Prescribing Centre to primary care trusts, which are referred to in this Question? What enforcement exists and what mandatory element do the guidelines have or can the primary care trusts simply ignore them?

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My Lords, the guidance is basically information guidance; it is not mandatory. The National Prescribing Centre does what its title suggests: it offers advice on prescribing. It is separate from, but partly funded by, NICE and therefore it often provides guidance which backfills the advice provided by NICE. However, it does not give mandatory advice to doctors which they must follow in terms of prescribing.

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My Lords, I declare an interest as a diabetic. I am someone in the Westminster village who has the condition just like many people outside. Is the Minister aware that injecting and using the strips at home is not only medically sound but also psychologically reassuring to those who do so? Will she take this opportunity to say to the House that, if there is any obstacle at any level inhibiting the free availability of the strips, she will see that that obstacle is removed?

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Yes, my Lords; the benefits that flow from self-management are specific. Patients are able to react to and correct for the information that they obtain and so manage their conditions. They can then live their lives, whether in work or in retirement, with a great deal more confidence. I entirely agree with what the noble Lord said.

On availability, anyone who is treated with medication will receive the blood testing strips free and anyone who qualifies for a free prescription will also receive them free. We certainly want obstacles to be removed, which is why we are anxious to ensure that the message about self-care goes out.

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My Lords, I too declare an interest as my husband is diabetic and I often have to test him. Is the Minister aware that often an error occurs when using the strips, as blood comes off the new ones, which are plastic and shiny? Is she aware that it is no luxury to have the strips; it is absolutely essential, as has been said? Is she aware that diabetes is increasing? With so many obese people it will increase and it must be taken very seriously.

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My Lords, I understand, having spoken to Members of your Lordships' House, that it is quite difficult to use the strips. Interestingly, the new technologies and the new machines that are being made available make the situation slightly easier. It is up to each doctor and each patient to negotiate what is best for them.

On the second point raised by the noble Baroness, Lady Masham, about obesity, there is a clear link with diabetes. That is why our policies to reduce obesity are indirectly also policies to help to prevent diabetes. Over the last year for which we have full information, the number of prescriptions for blood testing strips has increased by 10 per cent, which suggests that they are increasingly in use.