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Health: Diabetes

Volume 702: debated on Monday 23 June 2008

asked Her Majesty’s Government:

What was the scientific basis for the National Health Service’s recent announcement that self-testing of blood sugar levels by type 2 diabetes patients is unnecessary.

My Lords, as the noble Viscount may now be aware, the National Health Service has not made an announcement advising people with type 2 diabetes to stop self-monitoring their blood glucose, although media reports were ambiguous. In May 2008, the National Institute for Health and Clinical Excellence—NICE—issued guidance on the management of type 2 diabetes, which includes advice on the self-monitoring of blood glucose. NICE guidelines continue to advise that, as part of an integrated package that includes patient education, the self-monitoring of blood glucose can have benefits for some patients.

My Lords, I thank the noble Baroness for her Answer. Diabetics such as me will be reassured that NICE has come out with the decision that she has announced. NICE is not known for making hasty decisions. The decision is certainly in conflict with what was reported in the press. I am sure she is aware that diabetics have a difficult job combining exercise, diet, medication and monitoring, which is absolutely essential, to see that what they are doing is correct. Are we not seeing here a cost-benefit exercise, where the costs are too well known and the benefits not truly understood?

My Lords, as I said in my Answer, we have not advised people with type 2 diabetes to stop self-monitoring. However, the recent publication of two blood-glucose monitoring trials in the British Medical Journal has given rise to a debate about the benefits of self-monitoring. This is a useful addition to the debate, but the key point about self-monitoring is that it should be suggested on a patient-by-patient basis. It should include structured patient education so that the patient understands what to do with the information that they are collecting. I think the noble Viscount will agree that that is absolutely the key point. However, prescribing decisions about blood-testing strips are for local determination. Primary care trusts should not impose a blanket policy on testing strips for people with type 2 diabetes. Healthcare professionals should work with people with diabetes to make joint decisions about the value of self-monitoring blood glucose and prescribe accordingly.

My Lords, like the noble Viscount, Lord Falkland, I declare an interest in that I have type 2 diabetes, as no doubt do many other noble Lords. Is my noble friend aware that I am terrified of blood and machines? However, when I started testing, I persevered, and like the noble Viscount I now find blood testing an invaluable guide. This morning, my test was high. I realised that I had eaten too many boiled potatoes last night and will not do so again. Will my noble friend do all she can to publicise—I do not think that she stressed this point—the potential benefits of blood testing to type 2 diabetes sufferers?

Boiled or whatever, my Lords, I am glad to hear that my noble friend is aware of that. He makes the point about the programme that he is part of. It was set up by the Department of Health and is called DESMOND—Diabetes Education and Self-Management for Ongoing and Newly Diagnosed—and it is vital for supporting people to manage their condition. It is about people with type 2 diabetes getting the right kind of education to ensure that they can self-monitor in the way that my noble friend referred to. The department recently issued further guidance to PCTs to the effect that they should use this as part of their ongoing programmes to support diabetes sufferers.

Nevertheless, my Lords, there is some confusion here. NICE has said that self-monitoring blood glucose should be available to all on the basis of individual need and not on the ability to pay. Yet PCTs in some areas, as we have just heard, are restricting or denying access to that test for type 2 diabetics. Will the Minister therefore tell us whether the next stage will be to deny NHS treatment for diabetes to people using private means to monitor their own blood glucose?

My Lords, the noble Baroness is stretching the points of various debates but the point is well made about local decision-making, which indeed is the point. Blood-testing strips are costly and make up a significant proportion of the total number of diabetes items prescribed. However, notwithstanding my noble friend’s squeamishness, for some people with type 2 diabetes the use of blood-testing strips for self-monitoring will help them to understand how diet, exercise and medication can impact on their glucose levels. Primary care trusts should ensure that where people with type 2 diabetes are self-monitoring they fully understand those results. They do form a part of the free overall care package which includes structured education in this matter.

My Lords, is the Minister aware that high blood sugar can be exceedingly dangerous and trigger a stroke? Can she say why these testing strips are so expensive? My late husband had diabetes, so I know a lot about it. The condition is extremely complicated.

My Lords, I cannot say why they are so expensive, but I will endeavour to find out. They are very important. They are not only about identifying glucose levels but about the whole health of the person with diabetes and all the related ailments that might go with it. The noble Baroness is perfectly right.

My Lords, I declare an interest as having just recently completed my first 40 years as a type 1 diabetic. Does my noble friend take with alarm the report in today’s Times about the high incidence of diabetes in children? Does she further recognise the important role of specialist diabetic nurses who advise on the regime that we diabetics observe and who can give advice on monitoring systems? Given the news that diabetic specialist nurses have on average some 300 patients when the ideal number is 70, is she not worried about advice for diabetics on maintaining good, healthy regimes?

My Lords, given my noble friend’s youth, he will know that managing diabetes in children is much more complex than it is for adults. The role of specialist nurses is important. We have urged PCTs to recognise the importance of specialist diabetes teams, including specialist nurses, and the role that they play in reducing hospitalisation and improving outcomes and the support that they can give to young people and their families and carers in enabling them to handle the complex juggling act that is required to manage their condition.