Type 2 Diabetes Recommended SMBG

Transcription

1 Herefordshire Diabetes Guideline for Self-Monitoring Blood Glucose (SMBG) Type 2 Diabetes Recommended SMBG Diet controlled/ metformin only/ combination of metformin and pioglitazone/dpp4/sglt2 or GLP1 Sulfonylurea /Sulfonylurea + other hypoglycaemic agent Pre insulin initiation Not routinely recommended Once per day at varying times which may be increased: During titration of medication When hypoglycaemia is suspected Prior to driving May need to increase testing during illness or if taking other medications likely to destabilise diabetes. 1 week only; intense monitoring ie 4 x daily On insulin Once daily basal insulin Twice daily Insulin Multiple daily injections During titration phase: 1 x daily fasting test (pre breakfast) When stable: 1 x daily at varying times 2 4 x daily at varying times i.e. before meal and bed At least 4 x daily: pre- meal and before bed. NB. Additional blood glucose tests will be required: When driving / during intercurrent illness/ if hypoglycaemia unawareness is suspected/treatment changes Herefordshire Self-Monitoring Blood Glucose Guidelines February 2018 Page 1

2 Type 1 Diabetes Recommended SMBG Twice daily insulin Multiple daily injections Insulin Pump Therapy At least 4 x tests daily At least 6 x tests daily NB. Additional blood glucose tests will be required: Intensifying insulin regimes to improve HbA1c Frequency of hypoglycaemia has increased The person has hypoglycaemia unawareness Driving as per DVLA guidelines During periods of illness Before, during and after physical activity When planning pregnancy, during pregnancy and when breast feeding. Diabetes in Pregnancy Recommended SMBG Diet + / - metformin Insulin 4 x daily At least 7 x daily Additional testing required if driving Herefordshire Self-Monitoring Blood Glucose Guidelines February 2018 Page 2

3 choice dependant on increasing complexity and cost Selecting an appropriate SMBG test strip for people with type 1 and type 2 diabetes Diet and lifestyle controlled diabetes SMBG not routinely recommended Oral therapy only SMBG recommended where there is a significant risk of hypoglycaemia or for short periods during illness or medication changes / for driving (gliclazide) Insulin alone or in combination with oral therapy SMBG recommended for all patients Offer patient a choice of test strips and compatible meters (unless patient meets restricted criteria as listed below) Cost effective SMBG test strips Choice dependant on: Meter company Test Strip Basic Monitoring Visually impaired Gestational diabetes Gestational diabetes / Medtronic Pump Carbohydrate counting / Paediatrics Blood Glucose & Ketone testing and for newly diagnosed type 1 diabetes Newly diagnosed Type 1 diabetes Where dexterity / lifestyle make using blood glucose strip unmanageable TEE2 WaveSense JAZZ (Wireless) AgaMatrix Accu-Chek Performa Nano Roche Contour Black Ascensia CareSens N Voice CareSens N Contour Next (Gestational) Contour Next (Link Pump) Ascensia Accu-Chek Expert Roche Dual Freestyle Optium Abbott Accu-Chek Roche TEE2 / 50 Strips 7.75 Lancet WaveSense JAZZ 8.74 AgaMatrix 28g Performa Fastclix Contour CareSens N CareSens N Microlet Contour Next Microlet Accu-Chek Aviva Fastclix PRO (50) Ketosens (10) FreeStyle Optium Neo Freestyle Optium ß-Ketone Test Strip Freestyle Lancets Accu-Chek Mobile 9.99 Fastclix Review patients face to face review to ensure patient needs are discussed as well as cost effectiveness review including frequency of use and product choice. NICE recommend structured assessment of SMBG at least annually. Herefordshire Self-Monitoring Blood Glucose Guidelines February 2018 Page 3

4 Cost effective insulin needles: Insulin Needles Size /100 Notes TriCare BD Viva Omnican Fine Mylife Penfine Classic Insupen Gluco RX Carepoint Gluco RX Finepoint 5mm/32g 6mm/32g 4mm/31g 6mm/32g 6mm/32g 4mm/31g 4mm/31g Review patients face to face annually as recommended by NICE 4.04 (90 pack = 3.64) 5.94 Safety Needles Size /100 Notes Unifine Pentips Plus Cost effective Lancets: Pen needle fittings are universal & single use only Discuss clinical needs Discuss injecting technique Needles longer than 6mm not recommended Longer needles may, in some cases, increase potential of inappropriate intramuscular injection of insulin resulting in hypoglycaemia See Forum for injection Technique leaflet. Avoid /review 33-gauge cost significantly more Provide suitable containers for collecting used needles and sharps. Sharps PIL & Sharps For patients unable to selfadminister insulin i.e. given by a district nurse/ healthcare assistant or carer. Lancet Pack Gauge Manufacturer /100 Size AgaMatrix Ultra Thin G AgaMatrix 2.72 CareSens G / 30G 2.95 FastClix (for Fastclix lancing device only) G Roche 2.95 Glucoject Plus Lancets 200* 33G A.Menarini 2.75 Mylife & Mylife Multicolour G Ypsomed 2.75 Microlet 200* 28G Bayer 3.72 Omnican Lance Soft G Braun 2.73 *Glucoject Lancets PLUS and Microlet are most cost effective when prescribed as 200 s. Herefordshire Self-Monitoring Blood Glucose Guidelines February 2018 Page 4

5 Meters/strips/lancets for Review For Review Cost Replaced by Cost Comments Compact (Roche) Discontinued TRUEresult (Nipro) Accu-Check Aviva Expert (Roche) Contour purple/blue/green and silver or Breeze 2 Multiclix (Roche) Softclix (Roche) Mobile (Roche) No longer available No longer available No longer available Select an appropriate option from formulary Accu-Check Performa Nano (Roche) - Contour (Black) Fastclix 5.90 Fastclix 5.90 Cost effective Sharps Bins A Sharps Disposal Patient Information Leaflet is available here. Mobile (Roche) has superseded Compact and is a more cost effective option. (Saving = 6.40 per pack) Not on CCG formularyplease select an appropriate option from formulary Only use Accu-Chek Aviva for patients carbohydrate counting change other patients to Accu-Chek Performa Contour Black meets with the most recent ISO accuracy standards. Fastclix is a drum of 6 preloaded lancets similar to Multiclix Fastclix is a drum of 6 preloaded lancets similar to Softclix *Most cost-effective option LARGE Sharpsguard Daniels Healthcare 5 Litre* 1.21 * For regular users of injectables e.g. insulin needles and insulin pumps. MEDIUM Sharpsafe Frontier Medical Group 1.8 Litre* 1.15* For patients who are occasionally injecting e.g. GLP1 pens, needles SMALL SMALL Sharpsafe Frontier Medical Group Sharpsguard Daniels Healthcare 1 Litre Litre 0.86 For patients blood glucose monitoring to dispose of used lancets. Herefordshire Self-Monitoring Blood Glucose Guidelines February 2018 Page 5

6 Education & Training Training updates with respect to NICE and local guidance will be organised via Diabetes Team Wye Valley NHS Trust, CCG Medicines Optimisation Team, Diabetes Forum and Practice Nurse Forum. Additional sessions can be organised to familiarise health care professionals with devices depending on local needs, contact Diabetes Team on Where using Commercial Sponsorship ensure compliance with NHS guidance. Patient Review in Primary Care Diabetic patients SMBG should be reviewed at the next opportunity, via face to face review, to ensure patient needs are discussed, as well as cost effectiveness review of usage and product choice to optimise resources and reduce waste. Insulin pump and paediatric patients will be reviewed by secondary care. NICE recommend structured assessment of SMBG at least annually. NHS savings in Herefordshire Hundreds of thousands of pounds savings per year are available by reviewing patients and optimising SMBG use. From meter & strips 200K/year, needles= 56k/year and lancets= 16k/year. Choice can also be made. Herefordshire Self-Monitoring Blood Glucose Guidelines February 2018 Page 6