Quality Standards for Diabetes Care Toolkit

Guidelines

Medication management

NICE Guidelines on medication adherence can be accessed at: www.nice.org.uk/guidance/CG76.

Blood glucose monitoring

The New Zealand Primary Care Handbook 2012 states that self-monitoring is recommended for insulin and for sulphonylureas, where motivated patients may benefit from routine self-monitoring of blood glucose (SMBG) to reduce risk of hypoglycaemia. While it is not generally recommended for Metformin and other oral hypoglycaemic agents, there are special occasions when SMBG might be considered for those:

at increased risk of hypoglycaemia

experiencing acute illness

undergoing significant changes in pharmacotherapy or fasting (eg, during Ramadan)

with unstable or poor glycaemic control (HbA1c >64 mmol/mol)

who are pregnant or planning pregnancy.

The International Diabetes Federation (IDF 2009) guidelines on self-monitoring of blood glucose by people not using insulin are summarised as follows:

1. SMBG should be used only when people with diabetes (and/or their caregivers) and/or their health care providers have the knowledge, skills and willingness to incorporate SMBG and therapy adjustment into the care plan in order to attain agreed treatment goals.

2. SMBG should be considered at the time of diagnosis to enhance the understanding of diabetes as part of patient education and to facilitate timely treatment initiation and titration optimisation.

3. SMBG should also be considered as part of ongoing diabetes self-management education to assist better understanding of the disease and provide a means to actively and effectively participate in its control and treatment, modifying behavioural and pharmacologic interventions as needed, in consultation with the health care provider.

4. SMBG protocols (intensity, frequency) should be individualised to address each person’s specific educational, behavioural, clinical and provider requirements for data on glycaemic patterns and to monitor the impact of therapeutic decision-making.

5. The purpose(s) of SMBG and using SMBG data should be agreed on by the person and the health care provider and documented, as should the actual reviews of data.

6. SMBG use requires an easy procedure for patients to monitor meter performance and accuracy.

Devices

Three devices for blood glucose monitoring are currently subsidised by PHARMAC. Information about funded and unfunded devices can be found at: www.pharmac.health.nz/assets/diabetes-blood-glucose-meters-comparison-2012.pdf.
All of the subsidised devices are produced by CareSens (CareSens II, CareSens N and CareSens N POP) and product information, videos demonstrating their use and owners’ manuals (with quick guides translated into 11 languages including Māori, Samoan, Cook Island Māori, Tongan and Tokelauan) can be accessed at: www.caresens.co.nz/.
Access to glucose monitoring devices is clearly related to funding and by subsidising a limited range of meters from a single source PHARMAC has limited the available options. However, they feel that the range offered is sufficient to meet the needs of New Zealanders with diabetes. The decision about which device to use should be made collaboratively between the individual and their diabetes specialist nurse/doctor. The relative merits of each device should be considered as well as the status, needs and lifestyle of the individual.
BPAC (2013) advises that ‘there is an online training module (toolkit) available for practice nurses and other health professionals, to provide education on the CareSens blood glucose meters and testing strips. This module provides 0.5 hours towards continuing professional development (CPD) requirements’ (p 2). The toolkit is available from www.goodfellowlearning.org.nz/.
BPAC (2012b) provides the following summary of the meters.