Joslin Advocates for SMBG

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This is an interesting turn of events. Normally I am the one complaining about the lack of self-monitoringof blood glucose, but now Joslin Diabetes Center is asking in theirbook Joslin's Diabetes Deskbook, 2nd Ed, Excerpt #4: Do YourPatients Self-Monitor Their Blood Glucose Enough? For this, Ihave to ask if they will appeal to the Centers for Medicare andMedicaid Services (CMS) to up the number of test strips that diabetespatients can be reimbursed.
I complain because people do not testenough and use the results to help manage their diabetes in as moreinformed manner. I appreciate Joslin's statement, “Itis imperative that people who are self-monitoring know what to dowith the results of their glucose checking so that they can takeactive steps to improve their control. They should be giveninstructions on how to interpret their results, what they can dothemselves in response to the results, and when they should call forhelp.” At least the authorsknow and understand the importance of education and that it should bepart of everydiabetes treatment plan.
Too many doctors do not even prescribea meter and test strips for patients on oral medications, meaningpatients with type 2 diabetes. This excerpt should be requiredreading for these self-important doctors. All doctors do eithergive out meters and prescribe test strips or inform their patientswhere to obtain testing supplies for people with type 1 diabetes andfor people with type 2 diabetes on insulin.
I like what is covered in chapter 3. They state that, “Goals of diabetestreatment need to be defined in terms of self-monitoring results.” This is a great statement, which patients with diabetes need tounderstand. This brings both patients and physicians into thepicture and makes each a participant. The patients are responsiblefor gathering the information, doing this diligently, and providingthis information to the physicians. Then the physicians areresponsible for taking this information and helping the patients setgoals (whether new or revised) to help then manage their diabetesmore effectively.
In summary, here are a few reasons whySMBG should be performed:1. To provide data about glucose patterns that can be used by thehealthcare team, working with the patient, to make treatmentmanageable.2. To provide data with which patients themselves can make dailydecisions on treatment adjustments.3. To provide feedback on how effectively the individual is managingdaily self-care routines, including medical nutrition therapy,physical activity, and medication use.
These are by no means the only reasonsand the tables uses are adapted from the American DiabetesAssociation and are therefore not ideal, but can only be interpretedas 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 theirdiabetes need to consider using these tables.
Another area of concern is a few of the“diabetes coaches” that tell their people not to give theinformation to their doctors. Granted some doctors do not know whatto do with the information, but they are on their way out of practiceas patients become more empowered. I have crossed paths with a fewof these “coaches” and know they are attempting to hide what theyare doing. Not that they are giving out advice that is out of line,but too often these “coaches” are practicing medicine without alicense. They may not have intended to, but they do cross the linetime after time.