NICE stance on SMBG for Type2

Self-monitoring of blood glucose levels

• The NICE GDG was aware of the debate surrounding the routine use of self-monitoring of blood glucose in people with type 2 diabetes, and assessed the available evidence (from systematic reviews and randomized controlled trials) to determine whether self-monitoring should be used to manage blood glucose levels in this group of people. 
  
  
• The GDG noted that while self-monitoring of blood glucose provides the potential for tight blood glucose control and therefore reduced the risk of diabetes-related complications, the possible impact of such control on hypoglycaemic events is important in determining the safety and acceptability to people with type 2 diabetes. 
  
  
• Based on the evidence identified (which was generally of low quality), the GDG agreed that although a statistically significant difference was generally observed in HbA1c levels in favour of self-monitoring, the small reduction of less than 5 mmol/mol (0.5%; the threshold for minimal important difference) was not clinically significant.
  
  
• The GDG agreed that self-monitoring would not be beneficial to people with type 2 diabetes, with the exception of certain groups of people, for example people on insulin therapy. 
  
  
• The GDG also highlighted clinical scenarios that may benefit from short-term self-monitoring of blood glucose, for example people being treated with drugs that can cause hyperglycaemia (such as corticosteroids). For people with acute intercurrent illness or infection, the GDG agreed that no evidence had been identified to indicate that short-term self-monitoring would be beneficial; however, it was agreed that it is useful to make clinicians aware of the potential risk of worsening hyperglycaemia during acute intercurrent illnesses in people with type 2 diabetes.
  
  
• Due to a lack of evidence, the NICE GDG was unable to make any recommendations on the frequency of self-monitoring of blood glucose or on specific target values for people with type 2 diabetes.
  
  

https://cks.nice.org.uk/diabetes-type-2#!scenario


Is it any wonder the NHS diabetes drugs bill is through the roof, many T2 are blindly following dietary guidelines unaware of the effects on blood sugars, I and many others know the value of SMBG and that's the reason we keep medications to a minimum

What a pathetic response from NICE.
I guess this what happens when you hand out meters to people who think all one has to do is to stop eating sugar.   If they are not willing to educate the general populace they will get garbage results fed into their analysis.

They could do a lot by simply redrafting the T2D dietary guidelines.
regards

"Based on the evidence identified (which was generally of low quality), the GDG agreed that although a statistically significant difference was generally observed in HbA1c levels in favour of self-monitoring, the small reduction of less than 5 mmol/mol (0.5%; the threshold for minimal important difference) was not clinically significant."

Then they are obviously doing it wrong. I have lost count of the number of times people have used Test Test Test to control their postprandials and reported drops in A1c of 5 - 8% and even over 10%.

Nurses (including one at Joslin) often come up with utter crap like "if you test after eating, of course your BG will be high, you're diabetic! You should wait until it comes down again to test" Duh! Total waste of a strip.

The all time worst

"If you test you will hurt your fingers. Then you won't be able to read Braille when you go blind!"